Child and Adolescent PsychiatryChild and Adolescent Psychiatry

An Overview An Overview

Alan ApterAlan Apter

Child Study Center

Schneider Children’s Medical Center of Israel

5 Groups of Disorders5 Groups of Disorders

Developmental Developmental

EmotionalEmotional

ConductConduct

Physical symptomsPhysical symptoms IntellectualIntellectual

Developmental DisordersDevelopmental Disorders

PDDPDD:

Pervasive Developmental Disorders

Autism Schizophrenia Dementia

SDD:SDD:

Specific Developmental Disorders

Dyslexia...

Emotional DisordersEmotional Disorders

DepressionDepression: Unipolar Bipolar Dysthymia Atypical Seasonal Suicidal Behavior

Anxiety:Anxiety: OCDOCD PDPD Social PhobiaSocial Phobia PTSDPTSD Strangers Anx., Strangers Anx.,

Seperation Anx., Seperation Anx., Phobia...Phobia...

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Mood Disorders

Unipolar 1 Parent -> 10% 2 Parents -> 25% MZ=50%, DZ=25%

Bipolar 1 Parent -> 25% 2 Parents -> 50-75% MZ=33-90% DZ=5-25%

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Depressionin Children & Adolescents

1970: Depression in children as entity

Preschool: 0.9%

School: 1.9%

Adolescents: 4.7% Age and

developmental stage =>clinical picture

Spitz, Bowlby: anaclytic depression

Difficult to diagnose before 7y

body language, posture, face

Conduct DisordersConduct Disorders

CD/ODDCD/ODD

Violating rights of Violating rights of othersothers

ADD/ADHDADD/ADHD

Attention Deficit with/without Hyperactivity

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“SEROTONIN RELATED” BEHAVIORS

Violence Aggression Impulsivity Suicidality

~Low CSF 5H-T

(Coccaro 1989)

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AAttention ttention DDeficit eficit HHyperactivity yperactivity DDisorderisorder

Epidemiology 3-5% School Child. MaleX3, 1st Child Parents Psychopath.

Etiology MBD? Frontal? Dopamine +NE Psychosocial Environment Final Common Pathway

Diagnosis Inattention- 6 Hyperactivity

Impulsivity: 6 total Before 7y, 2 settings

Functional, not PDDClinical

From infancy School!!!

Psychological Disorders with Psychological Disorders with Physical SymptomsPhysical Symptoms

TICS/TSTICS/TS EATING DISORDERSEATING DISORDERS SLEEP DIS.SLEEP DIS. ENURESISENURESIS ENCOPRESISENCOPRESIS

Intellectual DisordersIntellectual Disorders

MENTAL MENTAL RETARDATIONRETARDATION

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Mental RetardationMultiple causes (“Basket”)

Medical and Pedagogic Definition (DSM IV): < 70

Functional deficits, <18y

Axis II

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Mental Retardation B.L I.Q: 71-84 MILD50-70 MODERATE 35-50 SEVERE 20-35 PROFOUND <20

No simple correlation to adaptive functioning

5 Groups of Disorders5 Groups of Disorders

Developmental Developmental

EmotionalEmotional

ConductConduct

PhysiologicalPhysiological IntellectualIntellectual