Child Psychiatry

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.

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Child Abuse and Neglect

Effects on Child Development, Brain Development, Psychopathology, and Interpersonal Relationships

Neglect, physical violence and sexual abuse (broadly called child abuse) have profound and long-term development of a child. The long-term effects of chronic early maltreatment in a caregiving relationship (also called complex PTSD) a child can be seen in higher rates of psychiatric disorders, higher rates of addiction, and a variety of serious relationship problems. Child abuse is an intergenerational problem. Very often the perpetrators of abuse and neglect are profoundly damaged people who were abused and neglected. There are clear links between neglect and abuse and later psychological, emotional, behavioral and interpersonal problems.

The basis of this relationship is the impact that abuse and neglect in the developing brain. Daniel Siegel, medical director of the Infant and Preschool Service at the University of California at Los Angeles, has found important links between interpersonal experiences and neurobiological development (Developing Mind: Toward a neurobiology of interpersonal experience. Daniel J . Siegel, Guilford Press, 1999.) We know that a child uses the mother’s state of mind to regulate the child’s mental processes. It is through a relationship sensitive, responsive, and the care with primary care provider that the child develops the capacity for self-regulation, emotional control, regulation of behavior and cognitive skills such as cause and effect thinking, including others.

Develop the child’s ability to control their emotions and develop a coherent sense of self requires sensitive and responsive parenting. The National Adoption Center found that 52% of adoptable children are the symptoms of attachment disorder. In another study by Cicchetti, Barnett and [2], 80% of child victims of violence or abuse had symptoms of attachment disorders. The best indicator of the type of attachment of a child’s state of mind with regard to the setting of the biological mother. type of attachment to a biological mother before the birth of your child can predict with 80% accuracy for classification of attachment of the child of six years. It is a remarkable discovery. Finally, recent research by Mary Dozier, Ph.D. [3] has shown that the type of attachment to an adoptive mother has a profound effect on the type of attachment of the child. He noted that the type of attachment the child is similar to that of the adoptive mother, after three months probation.

These results strongly support a mechanism for non-genetic transmission of attachment patterns across generations. Children who have been victims of sexual abuse is a significant risk of developing anxiety disorders (2. 0 times the average), major depressive disorders (3. Mean of four times) the abuse of alcohol (2. Average of 5 times ) drug abuse, (3 8. the average), and antisocial behavior (4. average 3 times) [4]. In general, the left brain is the site of the language of motor activity in the right side of the body and logical thinking based on the language. The right hemisphere of the brain responsible for motor activity on the left side of the body, perceptions of context, facial recognition, treatment, relational and emotional perception, and in general. The orbitofrontal cortex (the brain behind the eyes) is responsible for the integration of emotional responses generated in the limbic system with higher cognitive functions such as planning and language in the prefrontal lobes of the cerebral cortex. Left orbitofrontal cortex is responsible for memory creation while the right orbitofrontal cortex is responsible for memory retrieval. operation requires an integrated right and left hemispheres. A large number of synaptic connections between neurons are formed during the first year of life in the middle of the second year of life. An integrated brain requires connections between the hemispheres by the corpus callosum. Abused and neglected children have smaller corpus callosum that children are not battered. Abused and neglected children have been integrated bit hemispheres.

This poor integration of hemispheres and underdevelopment of the orbitofrontal cortex is the basis of symptoms such as difficulty regulating emotion, lack of cause and effect thinking, inability to accurately recognize emotions in others the child’s disability express their own feelings of the child, the sense of history and autobiographical self inconsistency and a lack of awareness. The brains of abused children are not so well integrated that the brains of abused children. This helps explain why abused children have serious difficulties with emotional regulation, integrated functioning and social development. development of awareness and capacity for empathy are largely functions of the orbitofrontal cortex. When the development in this region of the brain is blocked, there are important social and emotional difficulties. Interestingly, the orbitofrontal cortex is sensitive to the recognition of faces and eyes. Abused children often have attachment disorders because of its lack of sensitivity of the biological parents of response interactions with children.

Early interpersonal experiences have a profound impact on the brain because brain circuits responsible for social perception is the same as those that integrate functions such as the creation of meaning, the regulation of states of the body, emotion regulation, the organization memory and interpersonal communication skills and empathy. stressful experiences that are overtly traumatizing or chronic cause chronic elevated levels of neuroendocrine hormones. High levels of these hormones can cause permanent damage to the hippocampus, which is essential for memory. [5] On this basis one can assume that psychological trauma can affect a person’s ability to produce and maintain the memory and prevent the resolution of trauma. Child abuse show a variety of behaviors that can lead to a number of diagnoses. However, the effect of early abuse and neglect of children can be seen in several critical areas of development. These domains include emotional regulation, regulation of behavior, attachment, biology, flexibility of response, integrated and coherent sense of self through time, the ability to participate in an impact on the lineup with significant others ( empathy and emotional connectivity), the self-concept, cognitive and learning, and development of consciousness.

The effects of abuse in early child development are profound and lasting. It is the impact of abuse on the child’s brain development that causes the effects observed in a variety of fields, including social, psychological and cognitive development. The ability to control their emotions and emotionally attuned to another depends on early experience and development of specific brain regions. In early abuse leads to deficits in the development of these brain regions, the orbitofrontal cortex, especially frontal and corpus callosum, because the toxic effects of stress hormones in the developing brain. These results suggest that effective treatment requires a significant emotional relationship to listening. Siegel said: “As parents reflect with their securely attached children’s mental states that create their shared subjective experience, which will join them in an important co-constructive process of understanding how the mind works. The inherent characteristic of a Secure attachment – contingent, collaborative communication – is also a key element in how to facilitate the integration of internal relations in a child. [6] This has implications for the effective treatment of abused children. For example, when a therapeutic relationship, the client is able to reflect on aspects of traumatic memories and experience of the effects associated with those memories without becoming dysregulated, the client developing a greater capacity to tolerate increasing amounts of concern. Customer learns to regulate itself. The tuned resonance relationship between the client and the therapist allows the client to make sense (a function of the left hemisphere) memories, autobiographical representations, and affect (right hemisphere functions.) Effective treatments, such as the development of dyadic psychotherapy, can have important positive effects on later development. [2 Cicchetti] and Barnett, 1991. [3] ‘The integration of children in foster care: the role of caregiver state of mind, Child Development, vol. 70, pp. 1467-1477, 2001. [4] MacMillan, HL, et al. al., childhood abuse and lifetime psychopathology in a community sample, American Journal of Psychiatry, vol. 158 No. 11, pp 1878-1883, November 2001 [5]. McEwen, B., “The development of the cerebral cortex XIII: Stress and brain development – II” Journal of the American Academy of Child Psychiatry, 38, 101-103, 1999. [6] Siegel, 1999. P. 333.

Sleep During Infancy and Childhood

During infancy.

For three or four weeks after birth the infant sleeps more or less, day and night, only waking to satisfy the demands of hunger; at the expiration of this time, however, each interval of wakefulness grows longer, so that it sleeps less frequently, but for longer periods at once.

This disposition to repose in the early weeks of the infant’s life must not be interfered with; but this period having expired, great care is necessary to induce regularity in its hours of sleep, otherwise too much will be taken in the day-time, and restless and disturbed nights will follow. The child should be brought into the habit of sleeping in the middle of the day, before its dinner, and for about two hours, more or less. If put to rest at a later period of the day, it will invariably cause a bad night.

At the start the infant should sleep with its parent. The low temperature of its body, and its small power of generating heat, render this necessary. If it should happen, however, that the child has disturbed and restless nights, it must immediately be removed to the bed and care of another female, to be brought to its mother at an early hour in the morning, for the purpose of being nursed. This is necessary for the preservation of the mother’s health, which through sleepless nights would of course be soon deranged, and the infant would also suffer from the influence which such deranged health would have upon the milk.

When a month or six weeks has elapsed, the child, if healthy, may sleep alone in a cradle or cot, care being taken that it has a sufficiency of clothing, that the room in which it’s placed is sufficiently warm, viz. 60 degrees, and the position of the cot itself isn’t such as to be exposed to currents of cold air. It’s essentially necessary to attend to these points, since the faculty of producing heat, and consequently the power of maintaining the temperature, is less during sleep than at any other time, and therefore exposure to cold is especially injurious. It is but too frequently the case that inflammation of some internal organ will occur under such circumstances, without the true source of the disease ever being suspected. Here, however, a frequent error must be guarded against, that of covering up the infant in its cot with too much clothing throwing over its face the muslin handkerchief and, last of all, drawing the drapery of the bed closely together. The object is to keep the infant sufficiently warm with pure air; it therefore ought to have free access to its mouth, and the atmosphere of the whole room should be kept sufficiently warm to allow the child to breathe it freely: in winter, therefore, there must always be a fire in the nursery.

The child up to two years old, at least, should sleep upon a feather bed, for the reasons referred to above. The pillow, however, after the sixth month, should be made of horsehair; for at this time teething commences, and it’s highly important that the head should be kept cool.

During childhood.

Up to the third or fourth year the child should be permitted to sleep for an hour or so before its dinner. After this time it may gradually be discontinued; but it must be recollected, that during the whole period of childhood more sleep is required than in adult age. The child, therefore, should be put to rest every evening between seven and eight; and if it be in health it will sleep soundly until the following morning. No definite rule, however, can be laid down in reference to the number of hours of sleep to be allowed; for one will require more or less than another.Regularity as to the time of going to rest is the chief point to attend to; permit nothing to interfere with it, so only let the child sleep without disturbance, until it awakes of its own accord on the following morning, and it will have had sufficient rest.

The amount of sleep necessary to preserve health varies according to the state of the body, and the habits of the individual. Infants pass much the greater portion of their time in sleep. Children sleep twelve or fourteen hours. The schoolboy generally ten. In youth, a third part of the twenty-four hours is spent in sleep. Whilst, in advanced age, many don’t spend more than four, five, or six hours in sleep.

It’s a cruel thing for a mother to sacrifice her child’s health that she may indulge her own vanity, and yet how often is this done in reference to sleep. An evening party is to assemble, and the little child is kept up for hours beyond its stated time for retiring to rest, that it perhaps exhibited, fondled, and admired. Its usual portion of sleep is thus abridged, and, from the previous excitement, what little he does obtain, is broken and unrefreshing, and he rises on the morrow wearied and exhausted.

Once awake, it shouldn’t be permitted to lie longer in bed, but should be encouraged to arise immediately. This is the way to bring about the habit of early rising, which prevents many serious evils to which parents are not sufficiently alive, promotes both mental and corporeal health, and of all habits is said to be the most conducive to longevity.

A child should never be suddenly aroused from sleep; it excites the brain, quickens the action of the heart, and, if often repeated, serious consequences would result. The change of sleeping to waking should always be gradual.

The bed on which the child now sleeps should be a mattress: at this age a feather bed is always injurious to children; for the body, sinking deep into the bed, is completely buried in feathers, and the unnatural degree of warmth thus produced relaxes and weakens the system, particularly the skin, and renders the child unusually susceptible to the impressions of cold. Then, instead of the bed being made up in the morning as soon as vacated, and while still saturated with the nocturnal exhalations from the body, the bed-clothes should be thrown over the backs of chairs, the mattress shaken well up, and the window thrown open for several hours, so that the apartment shall be thoroughly ventilated. It’s also indispensably requisite not to allow the child to sleep with persons in bad health, or who are far advanced in life; if possible, it should sleep alone.