Child psychiatry and mental health

ADHD in ICD 10 known as hyperkinetic disorder vs ICD 11

in dsm5 age lifted from 7 to 12

stimulants contraindictions like strong history of substance abuse fam, seizures etc

https://www.autism360.com/rett-syndrome/

atrial septal defects

Marror

Ppt

Add from ward classes done below (includes adult psychiatry)

Common P/Cs - childhood impulsivity, conduct disorder, history of sexual abuse and other abuse , mood swings/borderline Bad, self harm, learning disabilities, autism. Can have overlap.

Features of aspergers - high functioning autism + egosyntonic OCD

"I will organise and schedule a family/case conference"

Adhd psychopathology - prefrontal cortex, dopamine & NE deficiency, and also motor areas. This area controls personality, emotions and impulses. Negative effects of methyl phenidate. TONI-3/4 (in LRH) (watch video) osce? Test of non verbal intelligent. Deviant quotient is like IQ. "mental age"

Negative effects of methylphenidate - addiction, so contraindication in family history of substance and alcohol abuse, even parents can be addicted. Must know methyl phenidate in and out important for viva. Take from the prescriber textbook. Agitation, anxiety, loss of appetite (so take after breakfast), insomnia so don't take in evening, CVS (so take baseline ecg and blood pressure), can lower seizure threshold (so not in epilepsy and organic brain stuff). Retards growth so take growth charts and reduced final height but for us small stature people like us is not important. Benefit is more than harm. Addiction is not there in kids but young adults will demand. And watch out for parents manipulating for more. Small percentage goes to adult adhd but usually condition resolves but inattention persists. After breakfast and after lunch but sometimes in lunch box for mid day dose but there are ER in foreign markets. Drug holidays concept. Alternate drugs atomexetine. Venlafaxine is activating ssri.

The monoamines are NE, Dopamine and serotonin but the most excitatory neurotransmitter is glutamate.

Toni vs draw a man

Psychotic symptomology is subjected to "guarding" (persecutory delusion involving the doctor) vs they don't know so can imply from behavior as in children and dementic patients. Behavior can imply hallications like talking to hand somatic hallucinations. And can also imply mood disorders. Esp in child.

Psychotic symptoms easier to treat than mania but both are of the easiest in psychiatry. Lithium is preferred mood stabiliser mania, bipolar, LD and borderline. Psychosis can be due to other causes like substance abuse, organic,

Persecutory themes are found in dementia, depression, paranoid schizophrenia and delirium. Vs grandiose delusion. In mood disorders this is mood congruent.

Mania/depression with psychotic features vs schizo effective disorders - severity of psychotic is less + congruent + psychosis always with mood disturbance. Ranking order also maintains in same intensity. There is something called mixed mood episode.

Rank order in Icd and chronological order in patients also matters. What if has brain tumor, alcohol dependanxd and psychotic symptoms

In conduct disorders - no concern for moral laws, cheating, taking drugs and assaulting,

In MSE we report what we see and elicit. But physical examination must actively engage and do. Must clarify with the consultant whether precontemplation and contemplation is in thought or insight.

Exam - must ask how much time we get to be with patient (30 minutes?).

Restless child management /RT - verbal, chemical, physical - verbal deescalation, benzos - olanzapine can be used but not used for adults, soft restraint Sometimes physical is done before chemical because they know its going to be aggressive

Negative reinforcement vs punishment - no privilege. Star charts. Also in adhd day schedule etc reinforcement restructures their priority list

ADHD

SNAP-4 score - can give both to both parents and teacher and compare coz of criteria mainly a clinical diagnosis. draw a man test for inattention. the prevalence is 5-10% upto 15% males are more prevalent. Genetic inheritence is 80%~. can be congenital or genetic. can be of three types. predominantly Inattention or predominantly impusive or combined. Three cardinal features. must ddx from poor parenting. inexperiences parents might think its normal. but only thebteacher will find out.

in child and adolescent clinic these are the cases - school refusal, internet addiction, first episode psychotic or mania, ADHD, neurotic disorders like OCD, nocturnal enuresis

what is the difference between negative reinforcement and punishment. instead of punishment can do positive and negative reinforcement to determine priority list and dopamine medications is a must. can reduce overall height but more benefit than harm. not so important in sl contexts. mother must be reassured about the effects of the drug coz pudumai and that it is beneficial drug. kid is not being drugged! sometimes there is rebound agitations and sometimes develop sleepiness for mild behavioral therapy, must train parents no punishment only negativ reinforcements. structuring the day - timetables and rules. side effects of methylphenidate is issomnia, anorexia, rebound agitations and sleepiness. so for insonmia dont take at night time. for anorexia take after breakfast.usually taken after brekafast and lunch. if needed there is a third dose in interval time. can put inside ounchbox and ask teacher to give. but child sometimes throws it away. Parents might abuse drug but not kid. they will demand. parents will say not effective increase the dose. therefore be sus of substance abuse. so ask Hx of substance abuse. A small % of childhod adhdh can persist through adulthood. children dont get adddicted but adolescent can get and then lo and behold they demand atomexetine can be given if dependant or addicted or side effects. other countries have MR. since dopamine increase can increase risk of spyhcosis in adulthood a little. In adult ADHD - hyperkinetic goes down but attention can persist.

some foods can trigger adhd but dont tell coz they will not give therefore malnututrition. But if they bring certain identified food, then say to avoid.