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Child Psychiatry

Introduction Child Psychiatry: Psychiatric disorders in children present are different from those of adults, since they arise in complex and intimate family relationships, and are influenced by the stage of child development. Children also present particular challenges for evaluation and treatment.
Psychiatric disorders present in childhood or adolescence are listed in Table

1. Pervasive developmental disorders hyperkinetic disorders specific development of neurological disorders emotional behavior of the psychiatric aspects of the elimination of child maltreatment Table 1 Classification of psychiatric disorders of childhood and early adolescence the development of some characteristics of normal normal development the child is presented in Table

2. It is essential to take into account the stage of development of the stage of the child for a psychiatric evaluation, which is accepted as normal in one stage to another will be abnormal. Early childhood experiences play an important role in determining what type of people we are as adults.
The role of parents is crucial in this. The child with the parents (or parent) who are loving and tolerant, however, able to establish and implement clear and reasonable limits likely to develop high self-esteem and a secure attachment to parents who provide a secure attachment model of others in later life. The theory of “attachment” was first described by John Bowlby in the 1950s. It stems from his study of young children separated from their mothers in the hospital. attachment behavior begins about 7 months and is clinging and unwillingness to separate from the primary caregiver, usually the mother. Serves to strengthen the bond between mother and son and has a role in the evolution of the protection of children against predators. A child is secured in position to use the mother as a secure base from which to explore the outside world can begin, and will also be able to react well to short-term separations. If the attachment is poor because the father does not meet the needs of children for care or detention, or is inconsistent, the child will be challenged to explore and separation.

This pattern of insecure attachment may persist throughout life, affecting adult relationships. Assessment of Children How psychiatric history is taken and that the child is considered dependent on age, confidence and language skills of children. Much of the story comes from parents and children who are willing to leave their parents can be seen alone. It is generally preferable to see only adolescents and their parents before establishing a relationship of trust with them. The interview should take place in a relaxed and friendly, with toys and drawing materials provided for children under 10 years. The history should include the following: Submission of complaints reported by the parent and child. It is important to take the child to ask about the complaint in a smooth, after winning their trust and talking about neutral topics. the recent behavior or emotional difficulties, including general health, mood, sleep, appetite, elimination, relationships, antisocial behavior, life and fantasy games and behavior at school. Personal history, pregnancy, birth, milestones (motor, speech, feeding, sphincter control, social behavior), medical history, separation of parents, schools attended and progress on them.

Family structure and function of construction of a genogram is often helpful. The relationships between family members should be asked about, and interactions observed during the interview. roads temperature features such as activity level, regularity of the functions (sleep, intestines, eating), the ability to adapt to new circumstances, the willingness to approach people or new situations, the quality and intensity mood, quality of relationships within and outside the family, care and persistence can be seen from a very early age. A mental status examination of the child must be completed, although often based on behavior and watch them play. The following should be considered: the future looks for any abnormalities, bruises, cuts or scratches and the appropriateness of dress. performance level of activity, interactions with parents, motor function, attention and task persistence. Tell articulation, vocabulary and language use. resentful mood happy, happy, sad, depressed, anxious, hostile. Thoughts and speech content of the fantasy life, for example by asking the three magical wishes. The evaluation should be supplemented by physical examination and talking with informants involved with the child or the family as the family doctor, teacher, school psychologist, or social services. An investigation may be made, intelligence tests and tests more frequently in the university, such as standardized tests of reading. Pervasive developmental disorder (autism) Autism is a serious disorder that begins early and out the third anniversary. It is characterized by a lack of social relationships, language development and poor resistance to change and restricted and repetitive behaviors and interests. These children do not take into account or respond to the emotions of others or of social cues. They do not adapt their behavior appropriately to new environments, and are very limited in their game, they rarely participate in “pretend play. In general, soft toys to choose not unusual and can bind to a particular object and refuse to separated from it. Some have very limited language skills, and abilities that are present are not used in social conversation with others.
Three-quarters have a serious mental disability. Autism has a prevalence of 4 to 10,000 and is three times more common in boys than in girls. It is associated with brain damage, in some cases, genetic factors appear to play an important role in the etiology. There is no specific treatment available. Families need a lot of support issues and advice and behaviors can be managed with behavioral therapy. The result is generally low, with only 15% never get an independent operation. 0-1 rapid development of motor totally dependent – on foot through a year of seven months attachment behavior for about 1-2 years begins to dry daily tantrums and separation anxiety 2-5 years to develop complex language skills departure identification of sexual identity with parents at the beginning of the formation of the consciences of living life Fantasy is considered the center of his world of 5-10 years of identity as a girl or boy able to separate and the mother’s personality attributes acquired by the end of this period of adolescence persist into adulthood puberty – 11 to 13 years in girls and 13-17 for males ADJUSTMENT personal identity of the autonomy of parents to learn to work and develop the skills necessary to become self-supporting peer relationships is very important group development Table 2 Normal small specific developmental disorders of these disorders, specific skills such as reading, spelling, knowledge of arithmetic and language interrupted.
The problems are present from early childhood. To make a diagnosis of pervasive developmental disorder Specific, acquired brain injury or disease must be excluded and that the child must have a reasonable opportunity to acquire these skills at home or at school. The causes of specific developmental disorders are not known with certainty but is believed to come of abnormal cognitive processes. All of them are much more common in boys than in girls. specific reading disorder is particularly common with a prevalence of 5-10%. The most common problems include reading distortions or additions of words or parts of words, slow reading rate and the loss of space in the project. Although the specific reading disorder is not due to insufficient enrollment, absenteeism is a common consequence of difficulties in school. disorders of conduct and specific disorders reading often co-exist. hyperkinetic disorder in the United States this is called deficit hyperactivity disorder (ADHD). The main features of the disease are hyperactivity, restlessness, attention, distractibility and impulsive behavior. These children are often clumsy , accident prone and have trouble with their parents and teachers, because they act without thinking. Other children are often avoided and may become socially isolated. The symptoms usually occur at an early age but is more frequently diagnosed in June -9 years in which there is a prevalence of about 8%. It is three times more common in boys than in girls. Several causes have been proposed, with genetic factors and parental allergies.

This is one of very few children psychiatric disorders treated with medications. stimulates amphetamines are used, such as methylphenidate, which has the paradoxical effect of reducing levels of activity and improvement of care. This translates into improvements in academic performance and development of friendship. “behavioral therapy, using a system of rewards for good behavior, it is also useful for these children. hyperactivity disorder tends to improve with age, the fourth only to the persistent problems in adolescence. Around half of them still have some features of the disorder in adulthood, which is often expressed as a behavior conduct. Conduct of the main features of the disorder conduct disorder are persistent antisocial behavior such as anti-bullying , severe temper tantrums, property damage from fire, theft, truancy, and persistent disobedience and rebellion. The child’s age must be taken into account, and the malice standard should not be regarded as a sign of conduct disorder. A third cases have a specific reading disorder, and there is considerable overlap with hyperactivity. The behavior problems are common, present in at least 4% of children with a peak between 12-16 years of age, and are three times more common in boys than in girls. There are two types of behavior disorders: behavior socialized. These children are able to make friends who usually work also behave antisocial. The bad behavior is usually more evident outside the home. Relations with adults can be good, but often there are difficulties with authority figures.
Unsocialised conduct disorder. These children have no friends, either because they were rejected by their peers, either because they deliberately choose to be isolated. Antisocial behavior occurs only. A certain degree of emotional disorder is often also present in these children. The causes of behavior disorders are a complex interaction between the biological structure of the child, family influences and environmental factors such as summersied Figure 1. The style of parenting is considered important. conduct disorders are likely to develop if parents do not set clear limits, control and manage development ineffective or inconsistent discipline. Improved parenting skills is likely to improve performance, including if other etiological factors are present. Other treatment approaches include family therapy, behavioral therapy, remedial courses and other activities to provide peer groups. The results are better for the group socialized. Two-thirds of the students unsocialised persistent conduct behavior in adulthood. The children’s emotional mood disorders are characterized by anxiety and depression. They are present in 2-3% of children and in particular for children are the most common psychiatric disorders in girls. generally have a good prognosis. separation anxiety disorder, it is normal for toddlers and preschoolers to feel some anxiety about actual or threatened separation from their parents. In anxiety disorder Separation anxiety is particularly severe or occurs in older children, and causes some problems in social functioning, as preventing children from attending school. Symptoms include persistent concerns about the separation of the attachment figure (usually the mother) and great distress if compelled to do so. Some refuse to go to sleep without his mother and nightmares about separation. parental overprotection is often present and other causes include child temperament and stressful events, especially those involving separation, such as family breakdown, loss or anxiety disorders of childhood diseases specific animal phobias, black or foreigners are normal in young children and rarely require treatment. GAD can occur and that the frequency of somatic symptoms charactersied, abdominal pain in particular. Family influences martial discord parents absent fathers violence, alcoholism, personality disorder of the brain conduct genetic parents of poor children, low IQ of temperament factors affecting the environment school care group social influences peer disciplinary code Figure 1 Performance of withdrawal symptoms, conduct disorder etiology of depressive illness with depressive illness are very similar in children than in adults – low-power mode, anhedonia, sleep and appetite changed and depressive thoughts . Fleeting suicidal thoughts are fairly common, but the suicide is rare. Moderate and severe depressive illness are rare in prepubertal children, with a steady increase in the impact on adolescents. The causes of depression and its treatment are similar to adults, although young children seem to be less sensitive to antidepressants than adults, the methods of psychological treatment that is preferred. school refusal the refusal of the child refuses to go to school because of specific concerns about school, the journey of the same or separation anxiety. This represents approximately 1% of all absences from school, and is much less frequent truancy in which the child hides his absence from school and their parents . The characteristics of children with school refusal are compared with those steers used in Table 1. Denial of the school must be addressed by returning the child to school as soon as possible that avoidance is likely to increase anxiety . a reintroduction of the quality necessary, with the support of the child and parents. Child abuse Child abuse can take the form of neglect, psychological abuse, physical or sexual abuse. It plays a role in the development of disorders psychiatric children may continue into adulthood. It is essential that all professionals who come into contact with children are aware of the possibility of abuse play a role in the problems posed by a child and his family. Table 3 Comparison characteristics of children with absences and truancy, school refusal the refusal of Absence Absence school known parents of the parents of the school day is hidden home alone or with parents may be days away from home with their pairs with the highest incidence at 11 years Increased fear of school age or separation anxiety disorders emotional n all social groups have increased in lower social classes No increase in discord parents dysfunctional marriage incidence parental overprotection severe parental abuse is difficult to measure than the majority of cases go unreported, and a definition of what constitutes abuse varies. The official figures of reported cases of abuse have increased in recent years, although this may be due to increased reporting rather than a real increase in abuse. A British study found that 12% of women and 8% of men have some form of sexual abuse before the age of 16 years. There are many factors that contribute to abuse of children. Some children are more vulnerable than others, such as those that are not desirable, an early separation from the mother, either mentally or physically disabled or have temperamental characteristics that make them difficult to handle. Some parents are more likely to be violent, especially those who were abused as children, living in poor socioeconomic conditions and have a realistic style of disciplining their children. The most common form of sexual abuse is father-daughter incest. Child sexual abuse may have a sudden change in behavior social or academic performance or behavioral problems. Some play games early and repeated sexual intercourse. It is important to give these children an opportunity to reveal their abuse, but great care must be taken to not increase their trauma. The social services must be informed any disclosure of sexual abuse by a child and start a day care procedure. The emotional effects of child sexual abuse can be addressed in individual psychotherapy with the child. Teens and adults can also be offered group therapy, which has the advantage of reducing feelings of isolation and help develop confidence and self esteem. One third of sexually abused children have no negative long-term, others are prone to depression, low self-esteem, sexual problems and tend to re- victimization in adulthood. Elimination Disorders enuresis enuresis is the involuntary emptying of the bladder occur after the age of five years in the absence of an organic cause. Bedwetting (nocturnal enuresis) is common, occurring in 10% more than 5 years, 5% of persons 10 years and 1% of 15 year olds. diurnal enuresis is less common. Enuresis is considered a principal, if there was a prior period of bladder control, and secondary if it follows a period of abstinence. It is twice as common in boys than in girls, and most cases are probably due to delayed neurological maturation that simply is corrected over time. There is often a positive family history same problem. The secondary enuresis may occur as a feature of regressive behavior in times of stress. To exclude the directors is composed of a physical cause, especially urinary tract infections, to reassure parents and encourage them to solve the problem calmly and tranquility. Implement a simple behavioral program as a graph or a wheel and the hood can be used. Encopresis Encopresis is inappropriate defecation, despite routine monitoring of the intestine. Most children are continent of faeces at the age of 3 years. At 8 years, 2% of males and 1% of girls suffer from encopresis. This may be due to inadequate toilet training or have a psychological cause of behavior that represents the child’s feelings of anger or regression to a time of stress. Constipation with overflow incontinence is the main differential diagnosis to exclude. Adolescents Adolescent social and emotional problems difficult to treat. For example, there are often disputes over the degree of independence they want and are allowed to have their parents. The peer group is very important and influential, and can provide valuable support to people to try new things away from family. You can also generate great concern by the group’s refusal , and may encourage criminal behavior. The development of sex is another potential source of confusion, anxiety and conflict. The evolution profile of psychiatric disorders such as children become teenagers. There is a marked increase in depressive disorders, especially among girls, and schizophrenia is much more common in late adolescence. Problems with alcohol and drug abuse and eating disorders tend to occur at this time. developmental disorders in general have been resolved.

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