MANAGEMENT OF COMMON PSYCHATRIC

DIODERS
 TYPES
• Mental Retardation
• Learning Disorders
• Motor Skills Disorders
• Pervasive Developmental Disorders
• Attention Deficit Hyperactive Disorders
•Feeding and Eating disorders of infancy or early
childhood
• Tic disorders
• Elimination Disorders
• Other Disorders
 MENTAL RETARDATION

Sub-average general intellectual functioning that

is accompanied by significant limitations in
adaptive functioning in at least two of the
following skills areas,
Communication, self care, home living, social-
interpersonal skills, etc
 DEFINITION
Definition:
Mental Retardation Refers to
significantly sub-average general
intellectual functioning, resulting in or
associated with, concurrent impairments
in adaptive behavior and manifested
during the developmental period.
 LEVELS OF MR

1. Mild Mental Retardation

2. Moderate Mental Retardation
3. Severe Mental Retardation
4. Profound Mental Retardation
1. Mild level
They can called as Educable Mentally
Retarded (EMR)
IQ range – 55 to 80
Capable of learning basic academic skills
of reading, writing and arithmatic.
Most children can learn vocational skills.
2. Moderate level
They called as Trainable Mentally Retarded
(TMR)
IQ range – 35- to 60
They were usually not admitted in
public schools. They can go to special
schools.
They need supervisory help.
Special teaching and training on basic skills
needed for day to day life.
3. Severe and profound level
Severe level IQ – 20 to 35
Profound level IQ – below 20
These children usually referred below the
TMR level as custodial
Usually theyremained at home
or under some residential facilities
MR
 LEARNING DISORDERS
 Reading Disorder: (Dyslexia)
 Mathematical Disorder: (Dyscalculia)
 Writing Disorder: (Dysgraphia)
MOTOR SKILLS DISORDERS
• Developmental Coordination disorder
• Impairment in the development of motor
coordination
• Not due to general medical
condition (Cerebral Palsy, Muscular
• Dystrophy)
Marked delays achieving motor
in milestones crawling,
(Walking, dropping clumsiness sitting),
things, performance , poor
in sports.
COMMUNICATION
DISORDERS
EXPRESSIVE LANGUAGE DISORDER

The difficulties with expressive language

interfere with academic or occupational
achievement or with social
communication
PHONOLOGICAL DISORDER
Failure to use developmentally expected
speech soundsthat are appropriate for
the individuals age and dialect
Errors in sound production, substitutions
of one sound for another (Use T for K),
omissions of sounds
 STUTTERING
• Disturbance in the normal fluency and time patterning
of speech that is inappropriate for the individual’s
age.
• Frequent repetitions/ prolongations of sounds or
syllables
• Interjections
• Broken words (pauses within a word)
• Audible/silent blocking
• Circumlocutions(word substitutions to avoid
problematic words)
• Words produced with an excess of physical tension
PERVASIVE DEVELOPMENTAL
DISORDERS
• Impairment in several areas of
development
• Reciprocal social interaction skills
• Communication skills
• Presence of stereotyped
behavior/interests/activities
• The qualitative impairments that defines these conditions are
distintly deviant relative to the individual’s
developmental level or mental age
 TYPES OF PDD
1. Autistic Disorder
2. Rett’s Disorder
3. Childhood Disintegrative
4. Asperger’s Disorder
1. Autistic Disorder

• Onset prior to age 3 years

• More frequent in males/boys
• Average or above average intelligence with
uneven cognitive skills
Symptoms
• Qualitative impairment in social
interaction
• Qualitative impairments in
communication
• Restricted repetitive and stereotyped
pattern of behaviours, interests and
activities
Causes
• Genetic
• Prenatal environment
• Perinatal environment
• Postnatal environment
 RETT’S SYNDROME
Rett syndrome is a rare genetic neurological
and developmental disorder that affects the
way the brain develops, causing a progressive
inability to use muscles for eye and body
movements and speech. It occurs almost
exclusively in girls.
• Discovered in the first two years of life
• Is a genetic disorder. Mutation in a particular
gene on the X chromosome.
Symptoms
• A slowing of head growth is one of the first
events in Rett syndrome
• Problems with muscles and coordination
• The child loses any purposeful use of her
hands
• stops talking and develops extreme social
anxiety and withdrawal or disinterest in other
people.
Rett’s Syndrome
CHILDHOOD DISINTEGRATIVE
• Childhood disintegrative disorder is also known
as Heller's syndrome. It's a very rare condition in
which children develop normally until at least
two years of age, but then demonstrate a
severe loss of social, communication and other
skills.
• Childhood disintegrative disorder is part of a
larger category called autism spectrum disorder.
• Develop normally through age 3 or 4
Childhood Disintegrative
A child who is affected loses:
• Communication skills
• Nonverbal behaviors
• Skills they had already learned
Symptoms
• Delay or lack of spoken language
• Impairment in nonverbal behaviors
• Inability to start or maintain a conversation
• Lack of play
• Loss of bowel and bladder control
• Loss of language or communication skills
• Loss of motor skills
• Loss of social skills
• Problems forming relationships with other
children and family members
 ASPERGER’S DISORDER
• Children with Asperger's syndrome typically function
better than do those with autism
• Children with Asperger's syndrome generally have
normal intelligence and near- normal language
development
• They may develop problems communicating as they
get older.
• Asperger's syndrome was named for the Austrian
doctor, Hans Asperger, who first described the
disorder in 1944.
Symptoms
• Problems with social skills
• Eccentric or repetitive behaviors
• Unusual preoccupations or rituals – Ex: getting
dressed in a specific order
• Communication difficulties
• Limited range of interests
• Coordination problems
• Skilled or talented
Asperger’s Syndrome
ATTENTION DEFICIT HYPERACTIVE
DISORDER (ADHD)
ADHD
• ADHD is a common behavioral disorder
that affects about 10% of school-age
children.
• Boys are about three times more likely
than girls to be diagnosed with it,
though it's not yet understood why.
• Of course, all kids (especially younger
ones) act this way at times, particularly
when they're anxious or excited.
• But the difference with ADHD is that
symptoms are present over a longer
period of time and happen in different
settings.
What is ADHD?
• ADHD is a neuro developmental disorder
affecting both children and adults.
• It is described as a “persistent” or on-going
pattern of inattention and/or hyperactivity-
impulsivity that gets in the way of daily life or
typical development. Individuals with ADHD may
also have difficulties with maintaining attention,
executive function (or the brain’s ability to
begin an activity, organize itself and manage
tasks) and working memory.
ADHD -SUBTYPES
• ADHD broken down into three subtypes, each with its own
pattern of behaviors,
1. An inattentive type
2. A Hyperactive-impulsive type
3. A Combined type
 AN INATTENTIVE TYPE
• trouble paying attention to details or a tendency to
make careless errors in schoolwork or other activities
• difficulty staying focused on tasks or play activities
• apparent listening problems
• difficulty following instructions
• problems with organization
• avoidance or dislike of tasks that require
mental effort
• tendency to lose things like toys, notebooks,
or
homework
• distractibility
A HYPERACTIVE-IMPULSIVE TYPE
• fidgeting or squirming
• difficulty remaining seated
• excessive running or climbing
• difficulty playing quietly
• always seeming to be "on the go"
• excessive talking
• blurting out answers before hearing the full
question
• difficulty waiting for a turn or in line
• problems with interrupting or intruding
A COMBINED TYPE
• A combination of the other two type, is
the most common
TREATING ADHD
• ADHD can't be cured, it can be
but successfully managed.
• ADHD is best treated with a combination of
medicine and behavior therapy.
• It's important for parents to actively
participate in their child's treatment plan,
parent education is also an important part of
ADHD management.
 FEEDING AND EATING
DISORDERS OF INFANCY OR
EARLY CHILDHOOD
 Feeding and Eating Disorders of
Infancy or Early Childhood

• If a child loses a lot of weight suddenly or

is small for their age and doesn't seem
to growing normally, it may be a sign
that a feeding or eating disorder is
present.
• When malnutrition is not caused by a
medical problem, it is referred to as a
feeding disorder of infancy or early
childhood.
TYPES

• Pica
• Rumination Disorder
• Feeding Disorder Of Early Childhood
 PICA
• Pica is a disorder that occurs when children persistently eat
one or more non-food substances over the course of at
least one month.
• Pica may result in serious medical problems, such as
intestinal blockage, poisoning, parasitic infection, and
sometimes death.
• Younger children with Pica frequently eat paint, plaster,
string, hair, or cloth.
• older children with Pica tend to eat animal droppings,
sand, insects, leaves, or pebbles.
• Adolescents affected by the disorder often consume clay
or soil substances.
RUMINATION DISORDER
• Children with Rumination Disorder repeatedly regurgitate and
spit out or re-chew their food following eating.
• This disorder usually develops in infants or young children. It
must last for at least one month before the diagnosis can be
made. Children with Rumination Disorder do not show nausea,
retching, or disgust associated with their rumination behavior,
and do not have associated gastrointestinal problems that can
account for the behavior.
 FEEDING DISORDER OF EARLY
CHILDHOOD

• A Feeding Disorder of Early Childhood

is diagnosed when a child does not eat
adequately and maintain proper
nutrition. This disorder, sometimes
referred to as "Failure to Thrive" leads to
weight loss or to difficulties maintaining
normal weight.
TIC DISORDERS
• The moves repeatedly, quickly, suddenly and
uncontrollably
body
• Any parts of the body- face, shoulders, hands or legs
• Involuntary, sudden, recurrent, stereotyped
movements motor
rhythmic. or vocalizations that are rapid and not
• It is irresistable
• Begin in childhood
• Ex for Motor Tics: eye blinking, nose twitching,
tooth
clicking, sticking out the tongue, hand clapping
• Ex for Vocal Tics: grunting, sniffing, barking, throat clearing
Diagnostic Criteria
• The presence of one or mote tics either motor or vocal – but
not both
• The tics occur many times a day, either daily or intermittently,
during a period of more than a year and without any tic free
period of 3 or more consecutive months.
• The tics cause marked distress or significant impairment in one
or more important areas of functioning, such as social or
occupational
• The symptoms began before age 18
• The tics are not due to the direct effects of some chemical
substances or some general medical condition
• The person has never met the criteria for Tourette’s Disorder
TOURETTE’S SYNDROME
• Is one type of tic disorder
• Begins as early as age 2
• Cause significant social and
functional difficulties for children
• More in boys than girls
Diagnosis
• Both multiple motor and one or more vocal tics have been
identified at sometime during the disorder, although it is not
necessary for them to occur in the same period.
• The tics occur many times a day and nearly everyday or they
occur intermittently, for a period of more than a year and
without any tic free period of 3 or more consecutive months.
• The tics cause marked distress or significant impairment in one
or more important areas of functioning, such as social or
occupational
• The symptoms began before age 18
• The tics are not due to the direct effects of some chemical
substances or some general medical condition.
ELIMINATION DISORDERS
• 2 TYPES
– Non-organic Enuresis
– Non-organic Encopresis
Non-organic Enuresis
• Enuresis is repetitive voiding of urine,
either during the day or night, at
inappropriate places.
• Enuresis is diagnosed only after 5 years of
age
• Enuresis can be either of:
– Primary type, where bladder control has never
been achieved or
– Secondary type, where enuresis emerges after a
period of bladder control.
Non-organic Encopresis
• Encopresis is repetitive passage of faeces at
inappropriate time and/or place, after bowel control is
physiologically possible. It is not due to the presence of
any organic cause, which is called as faecal incontinence.
• Encopresis can be either of:
– Primary type, where toilet training has never
been achieved or
– Secondary type, where encopresis emerges after a
period of faecal continence.
 OTHER DISORDERS
1. Oppositional Defiant Disorder
2. Conduct Disorder
3. Separation Anxiety Disorder
4. Childhood Schizophrenia
5. PTSD in Childhood
6. OCD in Childhood
7. Depression in Childhood
8. Elective (Selective) Mutism
9. Habit Disorder
1.OPPOSITIONAL DEFIANT DISORDER

• Child/adolescent behave in negativistic,

defiant, disobedient and hostile ways
towards authority figures
• If this behavior is severe enough to
interfere with the child’s functioning
and relationship with others then the
child may be ODD
Diagnostic Criteria
• A pattern that includes negativistic, defiant, disobedient and hostile behavior that
lasts at least 6 months and includes the frequent occurrence of at least 4 of the
following behaviors during that period (more frequently
• lose temper
• Argues with adults
• Actively defies or refuses to comply with adults’ rules or requests
• Deliberately annoys others
• Blames others for own mistakes or misbehaviors
• Is easily annoyed by others, touchy
• Is angry and resentful
• Is spiteful or vindictive
• These behavior cause clinically significant impairment in social, academic
or work related functioning
• These behavior do not occur exclusively as part of a psychotic disorder or mood
disorder
2. CONDUCT DISORDER

• Is often more serious in their consequences than

ODD because of the violation of important societal
norms and disregard of the rights of others
• Persistent behavior – include aggressive actions that
cause or threaten harm to people or animals
• Non aggressive conduct that causes property
damage, major deceitfulness or theft and
• Serious rule violations.
Diagnostic Criteria
• Three or more of these behavioural criteria must have been present in the last
12 months and at least one in the past 6 months
• Aggression – toward people – bullying, intimidation, use of weapons, physical
cruelty, forced sexual activity, mugging, purse snatching and aggression toward
animal.
• Destruction of property including fire setting, and other deliberate property
destruction
• Deceitfulness or theft including breaking into a building or a car, conning others
to obtain goods, stealing items of value
• Serious rule violation including staying out at night without parents’ permission
before age 13, running away from home, school truancy before 13
• These behavior do not occur exclusively as part of a psychotic disorder or mood
disorder
• Criteria are not met for conduct disorder or if 18 years or older for antisocial
personality disorder.
3. SEPARATION ANXIETY DISORDER
• Separation anxiety is normal in very young children
(those between 8 and 14 months old). Kids often go
through a phase when they are "clingy" and afraid of
unfamiliar people and places. When this fear occurs
in a child over age 6 years, is excessive, and lasts
longer than four weeks, the child may have
separation anxiety disorder.
• Separation anxiety disorder is a condition in which a
child becomes fearful and nervous when away from
home or separated from a loved one -
- usually a parent or other caregiver -- to whom
the child is attached.
Common symptoms of separation anxiety
disorder
• An unrealistic and lasting worry that something bad will happen to the parent
or caregiver if the child leaves
• An unrealistic and lasting worry that something bad will happen to the child if
he or she leaves the caregiver
• Refusal to go to school in order to stay with the caregiver
• Refusal to go to sleep without the caregiver being nearby or to sleep
away from home
• Fear of being alone
• Nightmares about being separated
• Bed wetting
• Complaints of physical symptoms, such as headaches and stomachaches, on
school days
• Repeated temper tantrums or pleading
4. CHILDHOOD SCHIZOPHRENIA

• Childhood schizophrenia is a severe brain disorder in

which children interpret reality abnormally.
• Signs and symptoms may vary, but they reflect an impaired ability to
function.
• It occurs early in life and has a profound impact on a
child's
behavior and development. And it requires lifelong treatment.
• The earliest indications of childhood schizophrenia may include
developmental problems, such as:
– Language delays
– Late or unusual crawling
– Late walking
– Other abnormal motor behaviors — for example, rocking or arm flapping
5. PTSD IN CHILDHOOD
• Children and teens could have PTSD if they have lived through an
event that could have caused them or someone else to be killed or
badly hurt. Such events include sexual or physical abuse or other
violent crimes. Disasters such as floods, school shootings, car crashes, or
fires might also cause PTSD. Other events that can cause PTSD are war,
a friend's suicide, or seeing violence in the area they live.
• Posttraumatic stress disorder, or PTSD, is diagnosed after a person
experiences symptoms for at least one month following a traumatic
event. The disorder is characterized by three main types of symptoms:
– Re-experiencing the trauma through intrusive distressing recollections of the event,
flashbacks, and nightmares.
– Avoidance of places, people, and activities that are reminders of the trauma,
and emotional numbness.
– Increased arousal such as difficulty sleeping and concentrating, feeling jumpy,
and being easily irritated and angered.
Diagnosis
Exposure to actual or threatened death, serious
injury, or sexual violation:
– Direct Experience
– Witnessing The Events As They Occurred To
Others, Especially Primary Caregivers (Note:
Does Not Include Events Witnessed Only In
Electronic Media, Television, Movies, Or Pictures.)
– Learning That The Traumatic Events Occurred
To A Parent Or Care Giving Figure
6.OCD IN CHILDHOOD
• Symptoms of childhood-onset OCD vary widely from child to child. Some
common obsessions experienced by children and adolescents with OCD
include:
– exaggerated fears of contamination from contact with certain people, or
everyday items such as clothing, shoes, or schoolbooks
– excessive doubts that he/she has not locked the door, shut the window,
turned off the lights, or turned off the stove or other household
appliance
– marked over-concern with the appearance of homework assignments
– excessive worry about symettrical arrangement of everyday objects
such as shoelaces, school books, clothes, or food
– fears of accidentally harming a parent, sibling or friend
– superstitious fears that something bad will happen if a seemingly
unconnected behavior is done (or not done)
• Symptoms of childhood-onset OCD
– Compulsive washing, bathing, or showering
– Ritualized behaviors in which the child needs to touch
body parts or perform bodily movements in a specific
order or symmetrical fashion
– Specific, repeated bedtime rituals that interfere with
normal sleep
– Compulsive repeating of certain words or prayers to
ensure that bad things don’t occur
– Compulsive reassurance-seeking from parents or
teachers about
not having caused harm
7.DEPRESSION IN CHILDHOOD
• If the Child’s sadness becomes
persistent, or if disruptive behavior that
interferes with normal social activities,
interests, schoolwork, or family life
develops, it may indicate that he or she
has a depressive illness.
The signs and symptoms

• The signs and symptoms of childhood

depression include:
• Changes in appetite -- either increased appetite
or decreased
• Changes in sleep -- sleeplessness or excessive
sleep
• Continuous feelings of sadness or hopelessness
• Difficulty concentrating
• Fatigue and low energy
• Feelings of worthlessness or guilt
• Impaired thinking or concentration
• Increased sensitivity to rejection
• Irritability or anger
• Physical complaints (such as stomachaches or
headaches that do not respond to treatment
• Reduced ability to function during events and
activities at home or with friends, in school or
during extracurricular activities, or when involved
with hobbies or other interests
• Social withdrawal
• Thoughts of death or suicide
• Vocal outbursts or crying
8.ELECTIVE (SELECTIVE) MUTISM
• Characterized by a marked, emotionally determined
selectivity in speaking, such that the child
demonstrates a language competence in some
situations but fails to speak in other (definable)
situations. The disorder is usually associated with
marked personality features involving social anxiety,
withdrawal, sensitivity, or resistance.
HABIT DISORDER
• Habit disorder is the 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.
• Habit disorders includes thumb sucking, nail
biting, hair pulling