精神病学英文版ppt课件

精神病学精神病学精神病学1CHILD AND ADOLESCENTS PSYCHIATRY AND MENTAL HEALTHSU Lin-yan M.D.CHILDANDADOLESCENTSPSYCHI2精神病学英文版ppt课件3OutlinePreface of Child and Adolescents PsychiatryMental RetardationAttention Deficit Hyperactivity DisorderOutlinePrefaceofChildandAd4DefinitionChildandAdolescentsPsychiatryistheacademicandclinicaldisciplinewhichstudyingandcaringforchildrenandadolescentswithEmotionaldisordersbehavioraldisordersdevelopmentaldisordersDefinitionChildandAdolescent5Thefieldofchildandadolescentpsychiatryisquiteyoung.1867MaudsleyH.firstdescribedinsanityofearly life in his book Physiolgy andpathologyofmind1950 formal training programs in childpsychiatrybecomepopularinAmerican1970quickdevelopmentThefieldofchildandadolesc6Thesocialsciences(socialandcommunalfactors,familyfunctioning,parent-childrelations)ManybasicsciencecontributetoknowledgerelevantchildpsychiatryThe biological science(braindevelopment)ThechilddevelopmentalpsychologyThesocialsciences(socialan7EpidemiologyChild and adolescent mental health is an essential part of overall health.World-wide up to 20%of children andadolescentssufferfromadisablingmentalillness(WHR,2000).World-widesuicideisthe3rdleadingcauseofdeathamongadolescents(WHR2000).Majordepressivedisorder(MDD)oftenhasanonsetinadolescence,acrossdiversecountries,andisassociatedwithsubstantialpsychosocialimpairmentandriskofsuicide(Weissman,1999)EpidemiologyChildandadolesce8EpidemiologyXINRE(1992)CBCL12.97%LiXR(1993)DSM-III-R14.89%It means that there are 46770000 childrenneedhelpinChina.EpidemiologyXINRE(1992)9Poor outcomesLightandBailey(1998)reportthatlongitudinalstudiesfindthatabouthalfthechildrenwithpsychiatricdisordersexhibitthesameorsimilardisordersyearslater.Conductdisorderrelatedbehaviorstendtopersistentintoadolescenceandadultlifethroughdrugabuse,juveniledelinquency,adultcrime,antisocialbehavior,maritalproblems,pooremployeerelations,unemployment,interpersonalproblems,andpoorphysicalhealth(Patterson,DeBaryshe,&Ramsey,1989).PooroutcomesLightandBailey10Present states of child mental health Most Scandinavia countries,manyEuropean countries and American:aboutonechildpsychiatristforevery50,000peopleinthepopulationIn China:less than 100 childpsychiatristthroughoutthecountryPresentstatesofchildmental11 Present states of child mental health1950s-1970s,afewdoctorsworkingin the child psychiatric clinic in bigcities.ThefirstChildpsychiatryclinicinChina was established in Nanjing byDr.TaoGuotai.Chinese Child Mental HealthBoard of Chinese Mental HealthAssociationwasestablishedin1989Presentstatesofchildmenta12Now,manychildpsychiatryresearch institutes have been built,including clinics,wards and caringcentersforchildrenandadolescentsinBeijing,Nanjing,Shanghai,Changsha,Chengdu,Fuzhou,Jinan,and so on.Child mental health clinics have alsobeenbuiltinmorecities.Now,manychildpsychiatryr13 Social need is increasingEmotional quotient(EQ,Garduer H andSaloveyP.)Theabilitytoaccurateappraisal and expression of emotions inoneselfandotherstoregulateemotioninaway that enhances living to recognize theconsensuallyagreeduponemotionalqualitiesofobjectsintheenvironment.TheachievementofonedependuponIQ20%EQ80%SocialneedisincreasingEmot14The WHO School Contest,held aspart of World Health Day 2001 whichhadthetheme“StopExclusion:DaretoCare”Chinese President Jiang Ze-min inhislettertoDrBlundtland,thesecretary-generalofWHO,hasemphasized Chinese government willmobilize the whole society to create asuitable environment for people withmentaldisorderstogobacksociety.TheWHOSchoolContest,hel15ClassificationWHO(1992):InternationalClassificationofDisease,TenEdition(ICD-10)APA(1994):DiagnosticandStatisticalManualofMentalDisorders,FourthEdition(DSM-IV)ClassificationWHO(1992):Inte16ChineseClassificationofMentalDisorders-Version3(CCMD-3)2000 7.Mentalretardation,anddisorderofpsychologicaldevelopmentalwithonsetusuallyoccurringinchildhoodandadolescence 8.Hyperkinetic,Conduct,andEmotionaldisorderswithonsetusuallyoccurringinchildandadolescenceChineseClassificationofMent17Classification71.1Specificspeecharticulationdisorder71.2Expressivelanguagedisorder71.3Receptivelanguagedisorder71.4Acquiredaphasiawithepilepsy71.9Otherorunspecifieddevelopmentaldisordersofspeechandlanguage 70.Mentalretardation 71.DevelopmantaldisorderofspeechandlanguageClassification71.1Specificsp18Classification72.1Specificreadingdisorder72.2Specificspellingdisorder72.3Specificdisorderofarithmeticalskills 72SpecificdevelopmentaldisordersofscholasticskillsClassification72Specificde19Classification72.4Mixeddisorderofscholasticskills72.9 Other or unspecified developmentaldisordersofscholasticskills 73Specificdevelopmentaldisorderofmotorskills 74MixedspecifieddevelopmentaldisordersClassification72.4Mixeddisor20Classification75.1Childhoodautism75.2Atypicalautism75.3Rettssyndrome75.4Childhooddisintegrativedisorder75.5Aspergerssyndrome75.9 Other or unspecified Pervasivedevelopmentaldisorders75PervasivedevelopmentaldisordersClassification75Pervasivedev21Classification80.1Attentiondeficitandhyperactivitydisorder80.2Hyperkineticconductdisorder80.9Otherorunspecifiedhyperkineticdisorder 80.HyperkineticdisorderClassification80.Hyperkineti22Classification81.1Dissocialconductdisorder81.2Oppositionaldefiantdisorder81.9 Other or unspecified conductdisorder 81Conductdisorders 82MixeddisordersofconductandemotionsClassification81Conductdiso2383.1Separationanxietydisorderofchildhood 83.Emotionaldisorderswithonsetspecifictochildhood83.2Phobiaanxietydisorderofchildhood83.1Separationanxietydisord2483.3Socialanxietydisorderofchildhood 83.Emotionaldisorderswithonsetspecifictochildhood83.91Generalanxietywithonsetspecifictochildhood83.3Socialanxietydisordero25Classification84.1Electivemutism84.2 Reactive attachment disorder ofchildhood84.9 Other or unspecified childhooddisordersofsocialfunctioning 84.DisordersofsocialfunctioningwithonsetspecifictochildhoodandadolescenceClassification84.Disordersof26Classification85.1Transientticdisorder85.2 Chronic motor or vocal ticdisorder85.3Tourettessyndrome85.9Otherorunspecifiedticdisorder 85.TicdisordersClassification85.Ticdisorder27Classification86.1Nonorganicenuresis86.2Nonorganicencopresis86.3 Feeding disorder of infancy andchildhood86.4Picaofinfancyandchildhood86.6Stuttering86Otherbehavioraldisorderswithonsetusuallyoccurringinchildhoodandadolescence 89OtherorunspecifiedchildhooddisordersofsocialfunctioningClassification86Otherbehavio28 Mental Retardation (MR)MentalRetardation29 Definition Mentalretardationisaconditionofarrestedorincompletedevelopmentofthemind,whichischaracterizedbydeficitsinintelligenceandsocialadjustment.Thedisorderemergesbefore18yearsold.Thelevelofintelligenceasshowninstandardizedpsychometrictestisdefinedasbelow70,whilethescoresfrom70-85aredefinedasborderlineintelligenceDefinitionMentalretardation30EpidemiologyWHO(1985):TheprevalenceofMRinthegeneralpopulationis4ofmildandsevereMR30(includemildMR);LiXR(1993)DSM-III-R22.2MorecommoninruralthanincitypopulationEpidemiologyWHO(1985):31Clinical Description(1)The range of IQ is from 50 to 69 and thepsychologicalageliesbetween9and12yearsold;(2)Poor academic performance with specificdifficulties in reading and writing,while at workthesepatientsareonlycapableofunskilledmanualjobs;(3)Independenceinself-care;(4)Intactabilitytocommunicateatordinarylevelin daily life despite difficulty in communicatingdifficultinformationinreadingandwriting MildmentalretardationClinicalDescription(1)Ther32Clinical Description(1)The range of IQ is from 35 to 49 andpsychologicalageisabout6to9yearsold;(2)Capabilityinsimplearithmeticbutnotuptoprimary school level.These patients can copesimplelaboringjobswithsimpleworkoutputandefficiency;(3)Capabilityofself-care;(4)Capability in daily life communication atordinaryleveldespitelimitedrangeofvocabulary ModeratementalretardationClinicalDescription(1)Ther33Clinical Descriptionmentalretardation(1)The range of IQ is from 20 to 34,andpsychologicalageisapproximatelybetween3and6yearsold;(2)Presence of marked motor impairment andotherassociateddeficitsintaskperformance;(3)Incapabilityofself-care;(4)Markeddeficitsinlanguagedevelopmentandincapabilityincommunicatingindailylife SeverementalretardationClinicalDescriptionmentalre34Clinical DescriptionProfoundmentalretardation(1)The range of IQ is under 20 andpsychologicalageisbelow3yearsold;(2)Completesocialdisabilitywithlackofawarenessofdangeroussituation;(3)Incapabilityinself-careandbladderorbowelcontrol;(4)Absenceofcommunicablespeech.ProfoundmentalretardationClinicalDescriptionProfound35EtiologyoChromosomalaberrations DownsyndromeGeneticdisordersEtiologyChromosomalaberratio36EtiologySingle-genemutations:Tuberoussclerosis,phenylketonuria and othermetabolicdisordersGeneticdisordersEtiologySingle-genemutations37EtiologyoFragileXsyndromeGeneticdisordersEtiologyFragileXsyndrome38EtiologyoMalformationsyndromesoPrader-Willi,Williams,andAngelmanduetomicrodeletionssyndromesGeneticdisordersEtiologyMalformationsyndr39EtiologyoMaternalinfections:Congenitalrubella,HIVoTeratogens:FetalalcoholsyndromeoToxemia:placental prematurityinsufficiencyoOther:radiation,traumaExposureEtiologyExposure40EtiologyoEncephalitisoToxins:LeadpoisoningoOtherpostnatalcausesTraumasobraintumorsPostnatalInfectionsEtiologyPostnatalInfectio41EtiologyPovertyEducationPsychosocialproblemsUnknownEtiologyPovertyPsychosocial42DiagnosisanddifferentialdiagnosisPsychometrictestsofIntelligenceGesell:03 years oldBayley:230 month PPVT:morn than 2 yearsWISC-RC:616 years oldC-WYCSI:46.5years oldDiagnosisanddifferentialdia43SocialAdaptiveAbilityScaleexistingconcurrentlywithrelatedlimitationsintwoormoreofthefollowingapplicableadaptiveskillarrears:communicationself-carehomelivingsocialskillscommunityuseself-directionhealthandsafetyfunctionalacademicsleisureandworkSocialAdaptiveAbilityScal44DiagnosisanddifferentialdiagnosisInmostcasesthereismentalretardationofvaryingdegreewhileinsomecasesthereareisolatedlocusofsuperior intellectual ability on abackgroundoflowgeneralintelligence.differentialdiagnosiswithAutismDiagnosisanddifferentiald45Qualitative impairment in reciprocalsocialinteractionsAbnormalitiesinlanguagedevelopmentRestricted,repetitive,and stereotypedpatternsofbehavior,interests,andactivitiesdifferentialdiagnosiswithAutismQualitativeimpairmentinr46OnsetafteranormalperiodhallucinationparanoiabehaviordisturbancedifferentialdiagnosiswithSchizophreniaOnsetafteranormalperiodd47TreatmentTrainingandrehabilitationTreatmentaimforcauseofdiseaseTreatmentaimforsymptomsTreatmentTrainingandrehabili48Attentiondeficithyperactivitydisorder(ADHD)Attentiondeficithyperactivi49 ADHDisoneofthemostimportdisordersthatChildandadolescentspsychiatriststreat.Itishighlyprevalent,makingupasmuchas50%ofchildpsychiatryclinicpopulations.Untreated,itpredisposesachildtopsychiatricandsocialpathologyinlaterlife.ThecoresymptomsofADHDistheinabilitytofocusattention,difficultymaintainingcontroloverimpulsivebehavior,andageneralizedhyperactivityDefinitionADHDisoneofthemostimp50EpidemiologyTheprevalenceofADHDinthegeneralpopulationisapproximarely3%to10%.LiXR(1993)DSM-III-R6.04%Morecommoninboysthaningirlsat a ratio of 9:1 in clinical sample 4:1inepidemiologicalsamplesEpidemiologyTheprevalence51ClinicalDescriptiondistractablebyenviernmentstimuliwhileconcentrating;failure to maintain persistenceattentionincalss;frequentomissionsofhomework;lackofpersistence,movefromoneactivitytoanotherInattentionClinicalDescriptionInattent52ClinicalDescriptionmotorrestlessnessandfidgety,run,jump,climb andgooffseatswhenthesituationdoesnotpermitasplayingorwhisperinginclassdifficulties in abiding byrulesingamesandimpatiencetowaitforonesownturn;HyperactivityClinicalDescriptionHyperact53ClinicalDescriptionintrudingonorinterruptingothersactivitiesteaseotherchildrenandtogetintroublesbeingeasilyfrustrantedandimpulsivewithemotionaldisplaylack of awareness of risk andhazards.ImpulsivityClinicalDescriptionImpulsi54ComorbidityLearningdisorders(LD):10%to92%Oppositionaldefiantdisorder(ODD):40to65%Conductdisorder(CD):42.7%to56%ComorbidityLearningdisorder55ClinicalDescriptionResulted in marked impairment insocialfunctioningintermsofacademicperformanceandinterpersonalrelationshipEarlyonsetusuallybefore7yearsofageClinicalDescriptionResulted56EtiologyCatecholaminebnormalitiesBlood,urine and CSF:lowdopamine and norepinephrineturnoverInteractionbetweenserotonin and catecholaminesystemsBiochemistryEtiologyCatecholaminebnorma57EtiologyHeritabilityisestimatedtobetween0.55to0.92Twinstudyconcordance51%inmonozygotictwins33%indizygotictwins;GeneticEtiologyHeritabilityisest5837yearsold11yearsoldADHDADHDfamilyfamily8yearsold37yearsold11yearsoldADHD59EtiologySPECT,PET,fMRI studies revealedlowercerebralglucosemetabolisminthesuperiorprefrontalcortex.NeuroimagingEtiologySPECT,PET,fMRIstud60EtiologyDysfunctionofparent-childrelationshipandfamilyFightingwithparentsPsychosocialfactorsEtiologyDysfunctionofpare61ADHDEffectsconductconductdisorderdisorderBadrelationshiplearninglearningdisabilitdisability yBad Bad Bad Bad self-self-self-self-esteemesteemesteemesteemSubstanceSubstanceabuseabuseAntisociaAntisociaAntisociaAntisocial l l l personalipersonalipersonalipersonalitytytytyADHDEffectsconductdisorderBad62Poor outcomesScott(2002)demonstratedincreasedcostsforcareandtosocietyinlateryearsfromthechildhooddiagnosisofconductdisorder.Leibson(2001)showedthatoveranineyearperiodthemedianmedicalcostsforchildrenwithADHDwere$4,306.00comparedwith$1,944.00forchildrenwithoutADHD.Thecostsareduetohigherratesofadmissiontohospitalemergencyandoutpatientdepartmentsandvisitstoprimarycarephysicians.PooroutcomesScott(2002)d63TreatmentCentralstimulantsMeihy1phenidate(Ritalin)PemolineAmphetamineAntidepressantsClonidineAtomoxetinePharmacologicalInterventionsTreatmentPharmacologicalIn64IndividualpsychotherapyEducationalinterventionFamilyinterventionMulti-modalitytreatmentPsychosocialinterventionsIndividualpsychotherapyMul65Family therapyFamilytherapy66Sensatory integration therapySensatoryintegrationtherapy67Sensatory integration therapySensatoryintegrationtherapy68Training of social skillTrainingofsocialskill69Play TherapyPlayTherapy70Thankyou!71