Nehru Arts and Science College

NEHRU ARTS AND SCIENCE COLLEGE

PG DEPARTMENT OF SOCIAL WORK

FOUNDATIONS OF PSYCHIATRY –II

(Special Paper-IV)

Unit I

Child psychiatry – their types –Developmental disorders, Specific developmental disorders,

habit disorders, hearing disabilities, Mental Retardation and Conduct disorders.

Unit II

Personality disorders, three clusters of Personality disorders, their symptoms and

management of Personality disorders.

Unit III

Psycho sexual disorders-types and treatment. Epilepsy- types of epilepsy, management of

epilepsy.

Unit IV

Alcoholic and substance abuse, Components of alcoholism, Causes of Alcoholism and

Treatment of Alcoholism.

Drug dependence– different types of drugs –Barbiturates, sedatives, cocaine, Heroine,

Steroids, Hypnotics.

Unit V

Trans cultural psychiatry- Cultural bound syndromes – their symptoms.

References:

Abraham Varghese 1982 Introduction to psychiatry, New Delhi: BI

Bhatia M.S 2001 Essentials of psychiatry,New Delhi: CBS.

James H.Seully 1979 Psychiatry,New Delhi: D.K

Niraj Ahuja 1998 Introduction to psychiatry, New Delhi: Rawat

Omkarnath G. 1977 Psychiatry- P.G.Test review,New Delhi: CBS.

Kaplan Synopsis of comprehensive text book of psychiatry

Robert J Walter 1998 Psychiatry for medical students, Chennai: Medical publishers

Samson G Irwin 2003 Abnormal Psychology, New Delhi: Prentice Hall

UNIT- I

Child psychiatry – their types –Developmental disorders, Specific developmental disorders,

habit disorders, hearing disabilities, Mental Retardation and Conduct disorders.

PART- A

1.  Reading Disorder in child psychiatry is called as…Dyslexia…

2.  Mathematics Disorder in child psychiatry is called as … Dyscalculia ..

3.  Expand DSM? Diagnostic and Statistical Manual

4. Communication disorder is also called as … Dysphasia.

PART – B

1.Define Child Psychiatry and its types?

Introduction

Child psychiatry the branch of psychiatry that specializes in the study, diagnosis, treatment, and prevention of psychopathological disorders of children, adolescents, and their families, child and adolescent psychiatry encompasses the clinical investigation of phenomenology, biologic factors, psychosocial factors, genetic factors, demographic factors, environmental factors, history, and the response to interventions of child and adolescent psychiatric disorders. The psychiatric assessment of a child or adolescent starts with obtaining a psychiatric history by interviewing the young person and his/her parents or carers. The assessment includes a detailed exploration of the current concerns about the child's emotional or behavioral problems, the child's physical health and development, history of parental care (including possible abuse and neglect), family relationships and history of parental mental illness. It is regarded as desirable to obtain information from multiple sources (for example both parents, or a parent and a grandparent) as informants may give widely differing accounts of the child's problems. Collateral information is usually obtained from the child's school with regards to academic performance, peer relationships, and behavior in the school environment. Psychiatric assessment always includes a mental state examination of the child or adolescent which consists of a careful behavioral observation and a first-hand account of the young person's subjective experiences. The assessment also includes an observation of the interactions within the family, especially the interactions between the child and his/her parents

Definition for Child psychiatry

The branch of psychiatry that deals with the diagnosis, treatment, and prevention of mental and emotional disorders in children.

The practice of child psychiatry differs from that of adult psychiatry in four important ways:

·  Children seldom initiate the consultation.

Instead, they are brought by a parents, or another adult, who thinks that some aspect the child's behavior or development is abnormal. Whether a referral is sought depends on the attitudes and tolerance of these adults, and how they perceive the child's behavior. Healthy children may be brought to the doctor by overanxious and solicitous parents or, teachers, whilst in other circumstances severely disturbed children may be left to themselves. A related factor is that psychiatric problems in a child may be a manifestation, of disturbance in other members of his family. When a child's problems have previously been contained within the family or school, the child may be referred when another problem, which reduces their capacity to cope with the child, arises in the family or school.

·  The child's stage of development must be considered

when deciding what is abnormal. Some behaviors are normal at an early age but abnormal at a later one. For example, repeated bedwetting may be normal in a 3-year-old child but is abnormal in a child aged 7. Also, the child's response to life events changes with age. Thus separation from the parents is more likely to affect a younger than an older child.

·  Children are generally less able to express themselves in words.

For this reason, evidence of disturbance often. comes from observations of behavior made by parents, teachers, and others. These informants often give differing accounts, in part because the child's behavior often varies with his circumstances, and in part because the various informants may have different criteria for abnormality. For this reason, informants should be asked for specific examples of any problem they describe, and asked about the circumstances in which it has been observed.

·  Medication is used less in the treatment for children than in the treatment of adults. Instead, there is more emphasis on working with parents and the whole family, reassuring and retraining children, and coordinating the efforts of others who can help children, especially at school. Thus multidisciplinary working is even more important in child than in adult psychiatry. Consequently, treatment is usually provided by a team that includes at least a psychiatrist, psychiatric nurses, a psychologist, and a social worker.

The disorders comes under Child Psychiatry

Developmental Disorder

What Is A Developmental Disorder?

Developmental disorders are disorders that occur at some stage in a child's development, often retarding the development. These may include psychological or physical disorders.

A developmental disorder occurs when a child does not acquire normal developmental skills expected for their age. This afects their ability to learn, behave and socialise. Although a developmental disorder may be present from birth, it often does not become evident until a child is challenged with more complex social and cognitive tasks.

They can be grouped into

Ø  Specific developmental disorder and Pervasive developmental disorders.

Specific Developmental Disorder A disorder that selectively affects one area of development, sparing essentially all other areas of development.

Specific developmental disorders categorizes specific learning disabilities and developmental disorders affecting coordination.

For example, dysgraphia is one type of specific developmental disorder. In dysgraphia there is inability to write legibly. Problems in dysgraphia may include fine-motor muscle control of the hands and/or processing difficulties. Sometimes occupational therapy is helpful. Most successful students with dysgraphia that do not respond to occupational therapy, or extra writing help, choose to use a typewriter, computer, or verbal communication.

The tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) has four categories of specific developmental disorder:

ü  specific developmental disorders of speech and language

ü  specific developmental disorders of scholastic skills

ü  specific developmental disorder of motor function

ü  mixed specific developmental disorder.

Specific developmental disorders are as opposed to pervasive developmental disorders (which affect development across the board), dyspraxias that affect multiple systems, cerebral palsy, and metabolic disorders.

Specific developmental disorders of speech and language:

·  Specific speech articulation disorder

·  Expressive language disorder

·  Receptive language disorder

·  Other developmental disorders of speech and language

·  Developmental disorder of speech and language, unspecified

Communication disorders:

·  Expressive Language Disorder

·  Mixed Receptive-Expressive Language Disorder

·  Phonological Disorder

·  Stuttering

·  Communication Disorder Not Otherwise Specified

Specific developmental disorders of scholastic skills (SDDSS):

·  Specific reading disorder

·  Specific spelling disorder

·  Specific disorder of arithmetical skills

·  Mixed disorder of scholastic skills

·  Other disorders of scholastic skills

·  Developmental disorder of scholastic skills, unspecified

Learning disorders:

·  Reading Disorder

·  Mathematics Disorder

·  Disorder of Written Expression

·  Learning Disorder Not Otherwise Specified

Specific developmental disorder of motor function:

·  Specific developmental disorder of motor function

Motor skills disorders:

·  Developmental Coordination Disorder

Mixed specific developmental disorder:

·  Mixed specific developmental disorder

Pervasive Developmental Disorder

The diagnostic category pervasive developmental disorders (PDD), as opposed to specific developmental disorders (SDD), refers to a group of five disorders characterized by delays in the development of multiple basic functions including socialization and communication that have traditionally been referred to as Autism.

Parents may note symptoms of PDD as early as infancy and typically onset is prior to three years of age. PDD itself does not affect life expectancy.

Classification

The pervasive developmental disorders are:

·  Pervasive developmental disorder not otherwise specified (PDD-NOS), which includes atypical autism (or is also called atypical autism), and is the most common;

·  Autism, the best-known;

·  Asperger syndrome;

·  Rett syndrome; and

·  Childhood disintegrative disorder (CDD).

The first three of these disorders are commonly called the autism spectrum disorders; the last two disorders are much rarer, and are sometimes placed in the autism spectrum and sometimes not.

Symptoms

Symptoms of PDD may include communication problems such as:

·  Difficulty using and understanding language

·  Difficulty relating to people, objects, and events; for example, lack of eye contact, pointing behavior, and lack of facial responses

·  Unusual play with toys and other objects

·  Difficulty with changes in routine or familiar surroundings

·  Repetitive body movements or behavior patterns, such as hand flapping, hair twirling, foot tapping, or more complex movements

·  Unable to cuddle or be comforted

Degrees

Children with PDD vary widely in abilities, intelligence, and behaviors. Some children do not speak at all, others speak in limited phrases or conversations, and some have relatively normal language development. Repetitive play skills and limited social skills are generally evident as well. Unusual responses to sensory information – loud noises, lights – are also common.

Diagnosis

Diagnosis is usually done during early childhood. Some clinicians use PDD-NOS as a "temporary" diagnosis for children under the age of 5, when for whatever reason there is a reluctance to diagnose autism. There are several justifications for this: very young children have limited social interaction and communication skills to begin with, therefore it can be tricky to diagnose milder cases of autism in toddlerhood. The unspoken assumption is that by the age of 5, unusual behaviors will either resolve or develop into diagnosable autism. However, some parents view the PDD label as no more than a euphemism for autism spectrum disorders, problematic because this label makes it more difficult to receive aid for Early Childhood Intervention.

Cure and care

There is no known cure for PDD. Medications are used to address certain behavioral problems; therapy for children with PDD should be specialized according to the child's specific needs. Some children with PDD benefit from specialized classrooms in which the class size is small and instruction is given on a one-to-one basis. Others function well in standard special education classes or regular classes with support. Early intervention, including appropriate and specialized educational programs and support services play a critical role in improving the outcome of individuals with PDD.

2. Define Habit disorders and its types?

Habit disorder is a term used to describe several related disorders linked by the presence of repetitive and relatively stable behaviors that seem to occur beyond the awareness of the person performing the behavior. As with other disorders, these behaviors cause impairment and result in negative physical and/or social consequences .

The first group of habit disorders is

·  Tic disorders (TDs): Tics are involuntary movements, sounds, or words that are “sudden, rapid, recurrent, nonrhythmic” . There are four kinds of tic-related habit disorders, and diagnosis depends on whether the tic is a vocal tic (e.g., repeated throat clearing), a motor tic (e.g., repeated blinking, arm movements), and whether the tic is simple (e.g., a short, brief noise or movement) or complex (e.g., a vocalization or noise that appears to take effort, like a spoken word, complex sound, or raising one’s arm up over one’s head).

·  Tourette syndrome (TS) is among the most the most well-known habit disorder, largely because of its presence in movies and television shows, but it is relatively uncommon. Children with TS have both vocal and motor tics, as opposed to one or the other. In addition to TDs, body-focused behaviors, such as recurrent hair pulling (trichotillomania [TTM]) and skin picking (SP), are also included within the habit disorders umbrella (Woods, Flessner, & Conelea, 2008). SP is not included in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (2000). However, given its similarities to TTM and its inclusion in research on other habit disorders, it is included here. While tics, TS, TTM, and SP all involve different behaviors, there is reason to believe these different behaviors represent diverse manifestation of a common underlying mechanism. Because of these similarities, the term “habit disorders” will be used throughout this section to discuss this group of disorders, and the specific disorder names (e.g., “trichotillomania” or “Tourette Syndrome”) will be used when those individual disorders are referenced.

·  Nail biting is a very common habit that mostly affects kids but it can be present in adults and older peopletoo. about it is manifested by biting one's fingernails or toenails during periods of nervousness, stress or boredom. It can be a sign of mental or emotional disorder but is commonly seen in intellectuals. The medical term for nail biting is chronic onychophagia. It belongs to the group of disorders called Stereotypic movement disorders. Often starting in childhood, nail biting can persist in some adults and become an irritating and unsightly nuisance. Some nail biters experience the habit with such severity that their nails are constantly bitten down to the maximum and bleeding, causing pain and often embarrassment.

Causes and Risk Factors

Underlying causes in the development of habit disorders are not well understood. However, as with many psychological disorders, the evidence suggests the presence of numerous factors, such as :

·  genetic vulnerability

·  learning and environment may contribute to the development and maintenance of these disorders.

·  Studies of families suggest the presence of genetic underpinnings in the development of TTM and TDs.