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Fifth stage
Psychiatry
Lec-8
د. الهام الجماس
7/10/2015
Adolescent psychiatry
Emotional disorder
Generalized anxiety is less common in adolescence than in childhood.
Social phobia often begin in early adolescence depressive symptoms are common in
adolescence
Conduct disorder
conduct disorder appear most often as truancy, offences( ) جريمة, abuse of alcohol and
drugs.
Manic –depressive psychosis
Is rare before puberty but increase in incidence during adolescence . The treatment is
similar to the adult but the drug doses is less and without ECT.
Schizophrenia
schizophrenia may begin in adolescence more in boys than girls , the clinical is like that of
schizophrenia in young adults , the treatment similar to that in adult.
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Child Abuse:
Physical abuse m, sexual abuse , Emotional abuse .
Child neglect ,non –organic failure to thrive .
Fetal abuse , Manchausen’s syndrome by proxy.
Fetal abuse –such as physical assault on the pregnant mother or taking by mouth
substance to harm the fetus .
Manchausen’s syndrome by proxy –unusual parental behavoure to suggest falsely that
the child ill .
I- Physical abuse (Non-accidental injury) :
Physical abuse refers to deliberate inflection of injury on a child usually by one of the
parents , it may result fractured bone or bleeding around the brain
Clinical features :
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The nature of the injury
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A previous history of suspicions injury.
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Delay in seeking help.
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Fearful response of the child to parents .
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The child is distressed , low self-esteem , aggressive behaviour.
Signs of physical abuse :
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Bruising , bites , Burns , Torn lips , Fractures , Subdural Haemorrhage , Retinal
haemorrhage .
Management
The Dr. and other member involved should be aware to the possibility of the child abuse .
The child should be refer to the hospital for admission investigation –like XR , CT scan in
suspected hemorrhage , All finding should be documented fully may be needed for legal
proceedings .
II- Sexual abuse
The term sexual abuse refer to the involvement of children in sexual activity to which they
cannot give legally informed consent .
Clinical features:
The children are more after female and the offenders usual male .
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The immediate symptoms include anxiety , depression, anger , unwanted pregnancy , low
self -0esteem .
Assessment
It is important to be alert to the possibility of sexual abuse and to give serious attention to
the child complain information from children is obtained carefully .
Examination carried out including genital and the anal region , specimens should be
collected from genital area and other relevant region .
Management :
Is similar to physical abused child , any sexual lesion should be treated carefully .
III. Emotional
The term emotional abuse refer to persistent emotional neglect or rejection sufficient to
impair a child physical or psychological development usually the parents require help for
their own emotional problems .
In sever case child need separation from the parents .
IV. Child neglect :
Child neglect includes neglect of the child’s physical or emotional needs (education , safety
or medical care )
Child neglect is a common reason for foster care.
V. Non organic failure to thrive
usually there has been rejection or hostility by parents weight and height are reduced for
the child age and there may be congenital and developmental delay, the child may be
irritable and unhappy when given adequate food and care , normal growth and
development restored in nearly all cases .