Psychiatry for child and adolescent

1. PSYCHIATRY FOR CHILD
AND ADOLESCENT

2. Children and Adolescent
I. Developmental disorders
1.Mental retardation:
o General intellectual functioning is below the average
o Difficulties to adapt to the social problem.
o Begins before the age of 18.
o Intellectual IQ is around 70 or less.
There are 4 levels of alteration
. Simple mental retardation: IQ 50 - 55 to 70
. Middle Mental retardation 35-40 to 50-55
. Severe/ serious mental retardation: IQ 20-25 to 35-40
. Deep mental retardation had lower IQs 20-25:

3. 2.Pervasive developmental disorders
Children with pervasive developmental disorder may show
a lifelong pattern of being rigid in style, intolerant of
change, and their prone to behavioral aggressive in response
to environmental demands or changes in routine.
Autistic or Autism disorder is the main pervasive
developmental disorder that is characterized by impairment
of development in social interaction and communication
with a restrictive repertoire of activity and interest.

4. Autism usually appears before 3 years but the first
signs may occur to one year. The key symptoms
of autism are made up of:
o Disruption of social interactions
o Disruption of verbal and nonverbal
o Early diagnosis is essential to limit the damage
in the evolution.

5. 3.SPECIFIC DEVELOPMENT DISORDERS
oLearning disorders: It may be diagnosed
when a child achievement on standardized
tests in reading, mathematics, or written
expression is substantially below what is
expected for his or her age, schooling, or
intelligence level.

6. C’d
o Motor skills disorders: It is impairment in the development of
motor coordination and it is characterized by child’s delay in
achieving motor aspect of the human body such as walking,
crawling, poor handwriting and sports performance.
o Communication disorders: It is one of four different problems
such as impairments in language expression, in the understanding
of language, in phonology. These impairments must be severe
enough to interfere with academic achievements or social
communication.

7. II. ATTENTION DEFICIT AND DISLAPTIVE
BEHAVIORAL DISORDERS
1. Attention Deficit Hyperactivity Disorder:
It is a conduct disorder marked by significant
problem of conduct because they are characterized
by acting out.
• child’s inattention to surrounding environment and
hyperactivity and /or impulsiveness.
• Both of these symptoms must persist for at least 6
months and cause clinically significant impairment

8. • Inattention is evidenced by careless mistakes in
schoolwork, not listening when spoken to, disliking
tasks that requires sustained mental efforts, and
being easily distracted.
• Hyperactivity is evidenced by running around
when the child is asked to stay seated, or talking
excessively.
• Impulsiveness is characterized by child’s difficult
waiting for his / her turn in activities, or interrupting.

9. 2. Conduct disorder:
o CD is also one of the most frequently diagnosed problems
for children.
o Boys show an incidence 3 to 5 times greater than girls.
o The main feature of CD is repetitive and pervasive
behavior in which the basic rights of others are violated.
o Look for behaviors that show aggression toward people,
animals, destruction of property, and serious violation of
parental or school rules.

10. 3. Oppositional defiant disorder:
It diagnosed when there is a consistent pattern of rejecting
adult authority.
o It is characterized by behaviors such as persistent fighting
and arguing, and refusing to comply with requests or rules
of adults, and blaming others for their own mistakes.
o The disorder is associated with problematic preschool
temperaments and a high degree of motor activity by the
child.
o The child may show low self esteem, minimal frustration tolerance, mood lability,
and precocious use of tobacco, alcohol or illegal drugs.

11. III. OTHER IMPORTANT DISORDERS
1. Feeding and eating disorders
o Pica: It is a disorder in which the child persistently eats
nonnutritive substances such plaster, paint, hair, cloth,
animal droppings, insects or leaves.
o This disorder can continue into adolescence and
adulthood.
o Rumination disorder: It repeated regurgitation and
rechewing food. The child bring up partially digested
food into the mouth, without any evidence of nausea and
the chews and re swallows it.

12. 4. Elimination disorders
o Enuresis: It is the involuntary excretion of urine
after the age at which the child should have
attained bladder control.
o Criteria for diagnostic are twice per a week for
duration of 3 months and that the child is at least 5
years of age.

13. . Encopresis: It involves soiling clothing with feces or
depositing feces in inappropriate places. Additional criteria
includes that the child is older than 4 years, that the soiling
occurs at least once per month, and that the soiling is not
the result of medical disorders such as mega colon etc.
5. Selective mutism: It is the persistent failure to speak in
specific social situations and it is of course related to a lack of
normal language skills or knowledge of a certain language. The
child can be excessively shy, fearful of embarrassment, withdraw, and
you may find oppositional behavior, especially at home.

14. 6. Stereotypic movement disorder: It is a pattern of motor behavior,
that is repetitive and nonfunctional. Examples of such movement are:
self biting, and picking at skin or body orifices. Onset of the disorder
may follow a stressful event.
8. Adult disorders in children and adolescence:
o Substance abuse
o Depression
o Bipolar disorder
o Psychosis
o Anxiety disorder (separation anxiety disorder- Attachment
problems, Obsessive-compulsive disorder

15. Substance abuse:
o Although a large number of adolescents try drugs or
alcohol, the majority do not progress to abuse or
dependence.
o Risk factors include the following: Cognitive
dysfunction, disorders of self- regulation, difficult with
planning, attention, need for sensation seeking, drugs
abuse parents, maternal depression, and anxiety.
o There factors that are though to protect against use
that include the following: Intelligence, problem-
solving ability, social facility, positive self esteem,
supportive family relationship, positive role model,
and affect regulation.

16. Depression:
•Population studies report a prevalence of major depression
and dysthymia of approximately 0.4% to 2 % in children and 4
% to 8% in adolescents.
•Symptoms of separation anxiety, phobias, somatic
complaints, auditory hallucinations, and behavioral problems
occur more frequently in children.
•Psychotic depression manifests in children as auditory
hallucinations instead of delusions, as seen in adolescents and
adults.
•Children and adolescents with depression have a comorbid
diagnosis in 40% to 70%; those with dysthimic disorder or
anxiety have a comorbid diagnosis in 30% to 80% of cases;
those with disruptive disorders have a comorbid diagnosis in
10% to 80% of cases; and those with substance abuse have a

17. Bipolar disorder:
•Children frequently present with atypical symptoms
that are often marked by labile and euphoric.
•Reckless behavior often leads to school failure,
fighting, dangerous play, and inappropriate sexual
activity.
•These children / adolescents often harass teachers
about how to teach the class.
•They may fail intentionally because they believe
they are being taught incorrectly.

18. Psychosis:
•Schizophrenia rarely presents before age 13 years, although
cases have been documented as young as 3 and 5 years.
•An onset before age 13 years usually has an insidious nature
and includes withdrawal, odd behavior, and isolation.
•Other developmental delays have been noted including
difficult in cognitive function, motor, sensory, and social
functioning.
• The presence of psychosis in preschool-age children is an
extremely difficult problem.
•Transient stress, imaginary friends. Delusional content and
hallucinations usually reflect development concerns.
• Hallucinations often include, monsters, and toys, and
delusions typically revolve around identity issues and are less
complex and systemic.

19. Anxiety disorders:
•Anxiety is universal human condition. Some
degree of worry and specific fears is considered
normal during the course of childhood.
•However, when the level of anxiety is excessive
and perturbs daily functioning, the diagnosis of
anxiety disorder may be appropriate.
•The anxiety disorder include: separation anxiety
disorder, and obsessive-compulsive disorder.

20. Separation anxiety disorder:
•The separation disorder do not concern only with
separation from their mothers or major attachment
figures, but children with separation anxiety disorder
suffer great distress when faced with ordinary
separations like going to school etc.
Obsessive-compulsive disorder:
• It characterized by intrusive thought ( pansee genant)
that are difficult to dislodge ( obsessions) or ritualized
behaviors that the

21. •A pediatric primary care sample revealed a 1- year
prevalence of anxiety disorders of 15.4% in 7- to 11 year’s
olds.
•The anxiety disorders include separation anxiety (3.5%),
simple phobia (2.4%), and social phobia (1%).
•Risk factors for development of anxiety disorders in
children include behavioral inhibition, insecure attachment,
developmental events, and traumatic events.

22. PSYCHIATRIC FOR
AGING PEOPLE

23. Introduction
o Elderly people are a vulnerable group to mental
health problems.
o Mental health problems for this age are manifested
in different ways and their causes as well.
o Biological, psychological and social components are
increased by elderly age, and approaches and
interventions must be adapted to this reality.
o Diseases frequently encountered in this age, are
dementia syndromes.
o Caregivers of seniors face the great challenge of
taking care of people who have lost the taste for life,
the ability to adapt and no longer believe the

24. In outlining comprehensive program, it is better to divide treatment
planning into four main categories:
Biological goals:
o In the medical domain, it is essential for a clinician to assess the
overall general physical condition of a patient, including
nutritional status.
o Underlying neurosensory deficits, including visual and hearing
difficulty, should be evaluated and treated, as these problems
can significantly impact on the functioning of the patient.
o The practitioner should order appropriate medical tests to
further define any medical pathology.
o The clinician should assess the patient’s current medication
regimen.

25. Psychological goals:
•The primarily psychological goals of an optimum treatment
plan are symptom reduction with diminished suffering,
stabilization, and restitution.
• These goals are typically achieved over an extended period
of time and require ongoing treatment with a patient.
Social and environmental goals:
•Formulation of appropriate social and environment goals for
the treatment plan should be based on an assessment of the
patient current living situation, the appropriateness of this
setting, and the person’s history of interpersonal interaction,
past and present. An attempt should then be made to match
a housing or living situation with the patient’s need for
structure, medical care, protection, stimulation, privacy and
autonomy. The practitioner may also aim to reduce social
isolation in a patient who is significantly withdrawn.

26. Family goals: A major goal in treatment planning is the
active participation of family members and other
caregivers. During his work with the family, the clinician
must attempt to understand the operating dynamic
within the family system and the role the identified
patient plays within this system. The therapist should aim
to reduce stress in the family and address issues that
could potentially interfere with treatment of the patient,
including collusion or sabotage.
Finally, in an attempt to maximize optimal functioning in a
patient, biological, psychological, social environment, and
family goals must be clearly outlined, and appropriate steps
must be taken to achieve this goals.

27. Aging is a degenerative process leading to dimunition of
the viability and increased vulnerability. All cells, organs
and systems are starting the process of declining.
Central nervous system:
Many signs of aging of CNS retain
• The presence of senile plaques between nerve cells
• The overall volume of the brain decreases,
Circonvulsions of cerebral cortex are atrophic.
• Synaptic function is less efficient, the synaptic
membrane viscosity increases, the quality of the
dendritic deteriorates, diminution of neurotransmitters
(dopamine, serotonin, acetylcoline, noradrenaline
• Reduction of certain enzymes needed for the synthesis
of neurotransmitters like the acetylcoline

28. Psychological and social aspects of aging
•Elderly generates inevitable disengagement, diminution
and social interactions, but this varies from one culture to
another.
•In Africa the elderly is the source of wisdom, where he is
given respect, while in Europe he may be considered as a
burden of the family.
•In this age people are more subject to losses that may
make them turn to psychiatric disorder. However it would
be wrong to conclude that the ageing is synonymous with
illness or disability.
Psychological aspects of ageing
Ageing of intellectual functions according to different
individuals depends on their level of culture, their interest,

29. Mental status examination
Perception
• Caution
• Language
• Memory
• Mood
• Reasoning and decision
• Functioning
• Behavior
Examination of the mental state is always accompanied
by other tests that could help to update the origin of
the dementia disorder.

30. Common characteristics
• Degradation of conduct of everyday life such as
bathing, dressing etc.
• Disorders of character and behavior with irritability
instability, opposition.
• Delusion of prejudice rather than persecution of the
immediate environment to which the elderly person
assigns all its woes (Malheur).
• Memory disorders with temporo-spatial disorientation
• Alteration of trial or judgment.
The problems that we will no longer address are:
depression, anxiety disorders, alcohol abuse, sleep
disorders, dementia such as Alzheimer's disease pick,

31. Depression:
o There is no criterion of depression that would apply specifically to the
elderly.
o Several features seem to distinguish depressed patients of adult age and
those of advanced age. The sad or dysphoric mood is often minimized or
even denied by the elderly.
o Feelings of guilt were reported less often, unlike the loss of interest and
anhedonia are common.
o Apathy and lack of interest are the signs of a late onset of depression.
o There are also other signs of the depression that are frequently
connected to other diseases that are constipation, fatigue, insomnia,
loss of appetite, slow of thought and movements.
o In elderly, slowdown pyscho motor could be considered wrong as a
depression.
o The hypochondria in elderly is often a sign of the existence of a
depression.
o These disorders hypochondriacs highlight the gastrointestinal tract.
o It will be that the person actually suffers depression once it has

32. Anxiety Disorder:
o Inadequacy related to physiological aging of the
organism have led to diminution of adaptability,
physical loss of autonomy create anxiety.
o Deterioration of socio-economic level and ability
to learn can contribute to insecurity and any
change can cause anxiety.
o It is noted that in elderly overload stressful events
leads to anxiety as well as boredom (les ennui).
o It is important for nurses to identify the source of
this anxiety.

33. Alcolism
o Loneliness, distress, decreased activity of all kinds
is factors that often lead to alcohol abuse.
o Some older people say that alcohol reduces
stress occasioned by large losses.
o Elderly are more vulnerable to the toxic effects of
alcohol.
o Medical complications of alcoholism among the
elderly may be confused with chronic diseases or
effects of medication.
o These conditions require clinical testing and early
treatment

34. Sleep disorder:
o Sleep of the elderly is characterized by
considerable diminution of deep sleep with
frequent nocturnal awakenings.
o It takes longer and sleep is unsatisfactory.
o Even if the duration of sleep lowers the person
will remain in bed because of fatigue.
o Some diseases like arthritis, respiratory diseases
may also be the origin of insomnia

35. Delirium:
o Disturbance of consciousness with reduced
ability to focus, sustain, or shift attention
o A change in cognition or the development of a
perceptual disturbance.
o The disturbance develops over a short period of
time and reduce intensity during the course of
the day.
o There is evidence from history, physical
examination, or laboratory findings that the
disturbance is caused by direct physiological
consequances of a general medical condition.

36. Demencia:
o It is an overall deterioration of intellectual functions,
evolution is progressive and it causes considerable
functioning handicap of the individual for all levels. Here
we will treat Alzhmeir disease which is a common
dementia and pick disease that has some similarities with
alzhmeir disease.
o Alzheimer's disease
This disease is characterized primarily by disturbances of
memory, and all intellectual disabilities.
o Gradually the individuals become confused and lose
consciousness of their environment and they become
unable to perform the most basic gestures of everyday life.
o It is called early when she appears at 65 or before, and late
after 65 years.

37. Alzheimer's disease :
o Impaired memory has short and long-term
impairment of the ability to learn new
information or recall previously learned
information.
o One or more of the following cognitive
disturbances:
1. Aphasia
2. Apraxia
3. Disturbance of executive functions (making plans,
having an abstract thought.

38. Pica disease:
o It is a degenerative disease with cerebral atrophy.
It is uncommon and it affects frequently women.
o The beginning is insidious, is gradually
deteriorating, with disorders of cases and loss of
self and capacity for abstraction.
o Basic faculties are relatively preserved.
o Mood may be euphoric or an emotional
indifference, apathy and unconsciousness of the
disorder. Gestural and verbal stereotypes.
o There is a temporo-spatial disorientation, but the
space is less perturbed.

39. Suicide:
o The rate of suicide among the elderly population is the
highest compared to other age groups and there are
more suicide attempts than suicide fatal.
o Depressive episodes, widowhood, physical illness,
psychiatric and other problems of life are considered as
the common causes of suicide.
o Suicide is sometimes carefully prepared with absence or
presence of indication sign.
o Suicidal behavior in elderly may be hidden or through
refusal to eat, absorb the abused drugs or alcohol.
o Caregiver accompanying the elderly should be
particularly careful because the suicide in elderly is the
last sign of autonomy and often only viable option to

40. Key elements of care
o Ultimate aim is delaying the effects of the
o deficit processes both physically and
psychologically.
o Maintaining relationships with the patient's
environment is also essential.
o Monitoring physical aspect to maintain autonomy
as long as possible with regard to hydration,
nutrition, elimination and skin care. Avoid
infantilize the person and make a place what it
can do itself. Pay attention to the risk of accident.
o

41. o Monitoring of mental aspect that can permit to
examine the intellectual memory, orientation,
maintain good personal image, encourage quality
sleep, propose activities to match the abilities of
the person and monitoring medication if the
person takes it.
o Attitude towards the family: be reassuring and
encouraging, informing them of what their loved
one suffers, solicit input from the family in care.