Pediatrics L4

Dodo Agladze
Psychiatric Disorders
Depression

Major depressive disorder - requires a minimum of 2

weeks of symptoms, including depressed mood, loss
of interest or pleasure

Prevalence of MDD in prepubertal children is 2% with in

adolescents the prevalence is 6-8%, with a female-to-
male ratio of 2:1

If untreated, major depression can become chronic in

10% of patients
Dysthymic Disorder
Is a chronic milder form of depression

Following symptoms are also required:

 changes in appetite
 sleep difficulty
 fatigue
 low self-esteem

 poor concentration or difficulty with making

decisions
 feelings of hopelessness
Depression
 Atypical depression
 Adjustment disorder with depressed mood
 Seasonal effective disorder

Treatment of depression involves psychopharmacy

and psychotherapy

First line antidepressant selective serotonin

reuptake inhibitors (SSRIs) have response rates of
50% to 70% despite high-placebo response rate
Depression

 Depression is a chronic and debilitating

illness that often starts in childhood or
adolescence

 It increases risk for future suicide, substance

use, and other psychiatric sequel
Bipolar Disorder
 Bipolar disorder consists of distinct periods
of mania that may alternate with periods of
severe depression

 A decreased need for sleep is a hallmark of

mania

 Treatment of BD includes decreasing acute

symptoms
Pervasive Developmental Disorders
 Autism spectrum disorders consists of 5:

1. Autism
2. Asperger syndrome
3. Childhood disintagrative disorder
4. Rett syndrome
5. Pervasive developmental disosorder
Autism
 Autism is characterized by lifelong marked
impairment in reciprocal social interaction,
communication, and a restricted range of
activities and interests

 Recommended screening for autism - 18 and 24

months of age

 Common comorbidities are mental retardation (up

to 80%), seizure disorder (25%), anxiety disorders
and attention-deficit/hyperactivity disorder
Schizophrenia
 Schizophrenia generally presents in adolescence or early
adulthood

 Childhood-onset schizophrenia is a rare disorder (<1 in

10,000 children)

 The symptoms of schizophrenia typically fall into four

broad categories:

1. Positive symptoms - hallucinations and delusions

2. Negative symptoms - a lack of motivation and social
interactions and flat effect
3. Disorganization of thoughts and behavior
4. Cognitive impairment
Schizophrenia

5 type:

1. Paranoid
2. Disorganaised
3. Catatonic
4. Undifferential
5. Residual
Psychosocial Issues

Failure to thrive (FTT) is a descriptive term

given to malnourished infants and young
children who fail to meet expected standards
of growth
Child Abuse and Neglect
 Child abuse is parental behavior destructive to the
normal physical or emotional development of a child

 Child abuse and neglect are considered in categories

that include: physical abuse, sexual abuse, emotional
abuse, and neglect

Child neglect - defined by omissions that prevent a

child’s basic needs from being met:

 Adequate food, clothing, supervision, housing, health

care, education, and nurturance
Physical Abuse
 The physical abuse of children by parents
affects children of all ages

 1% to 2% of children are physically abused

during childhood

 Diagnosis of physical abuse initially is

suggested by a history that seems
incongruent with the clinical presentation of
the child
Clues to Diagnosis of Physical Abuse
Sexual Abuse

 Child sexual abuse is the involvement of

children in sexual activities that they cannot
understand

 Approximately 80% of victims are girls

Homosexuality and Gender Identity
Development of sexuality occurs throughout a
child’s life
Sexuality includes: gender roles, gender identity,
sexual orientation, and sexual behaviors

Pediatrician who provides an open and

nonjudgmental environment may be a valuable
resource for an adolescent with questions
about heterosexual behaviors, homosexuality,
or gender identity
Development of Sexual Identity
 Sexual behaviors occur throughout childhood.

 Early in life, male infants can have erections and

female infants are capable of vaginal lubrication

 During the preschool period, masturbation

occurs in both sexes.

 Between 2 and 3 years of age, children identify

themselves as a boy or a girl
Terminology
Family Structure and Functions
 functions that families carry out in support of their
children can be categorized as; providing for physical
needs, emotional support, education, and
socialization

 There is little evidence that family structure alone is a

significant predictor of child health or development

 presence of a loving adult or adults, serving as a

parent or parents, committed to fulfilling a child’s
physical, emotional, and socialization needs is the
best predictor of good health and development
 Single-Parent
families

 Children with
Homosexual
Parents

 Adoption

 Foster Care
Questions for Adults and Children Related to
Family Violence
What is a role of Pediatrician?
Should Child Attend the Funeral?
End of L4