Emotional / Behavioral Disorders
(An Overview)
Dr. Mosleh A. Ismail
A. Professor FM
Objectives
By the end of the session the trainee will be able to :-
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Identify difference between Mental Health and Mental
Disorder!! What do you mean??
•
Define burden of the problem of Mental Disorders !!Why
Mental Disorders?
•
Identify normal development of the child
•
Define etiology of EB Disorders
•
Identify different forms of EBDs
•
Classify Mental Disorders (ICD-10-PHC & DSM-4)
•
Identify the different treatment modalities of EBD
!!Management plan
•
Identify causes of failure of treatment #Referral !!!
•
Prognosis of EMD
•
Identify preventive measures for EBD!! Preventive Issues for
EBD
‫ﺁﻳﺔ ﺭﻗﻢ ) ‪( ٨٥‬ﺳﻮﺭﺓ ﺍﻹﺳﺮﺍﺀ‬
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Thought
Orientation
Attention and Concentration
Memory
General Knowledge(Learning capability)
Intelligence(Problem Solving)
Judgment
Insight.
•
Mental Disorder is applied to patients in which
the outstanding feature is a disturbance of
the functions of the mind.
•
This may arise in 2 ways:# There are no organic changes in the brain
and
the
disorder
appears
entirely
functional.
#
There
are
existing
some
organic
pathological changes in the brain.
or
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A child behavior becomes a problem when
the
parents
find
it
intolerable
and
upsetting.
•
It
takes
two
parties
to
provides
a
problem- The child /The parents
•
Significance of any particular symptom is
the severity, duration and the associated
symptoms
About 7% of children by age 3 Ys have Moderate/S EB
Problems
Emotional BD are more than twice as common at home than at
school
Boys show more difficult behavior than girls
About 10% of children by age 5 Ys are disobedients
About 20% of children by age 7 Ys show some forms of Anti-S
behavior as destructive or disobedience + HADS
Eating disturbance occur in 25%-40% of PHC consultations
About 30% of children by age of 5 Ys have thumb sucking
/nail biting
• Inadequate School Achievement
• Family Dysfunction
• Social Stigma
• AQOL
• Financial burden
1- Enclosure stage
During the 1st year the baby is a part of his mother
2-Extension stage
It starts as the child became toddler and lasts
through the childhood
This stage (toddlerbood) is time for clashes with the
parents where the toddler tests them in any area of
behavior where they set rigid rules
Wise handling of this stage leads to peaceful
adolescence.
3-Stage of separation
At adolescence
•
Considering the normal development by parents
will lead to more
orientation
towards the
needs and drives of their growing children
This will lead to avoidance of mishandling of
disturbed
behavior
and
Proper
towards this particular behavior
response
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Hereditary (predisposing) factors
Acquired ( Precipitating ) factor
(1) Psychosocial (Environmental) F
# Morbid family environment
# Stresses
External stress (War, Natural disaster, Illness of
siblings..)
Internal stress (Chronic Illness / conflict)
(2) Physical Factors
Prenatally or Perinatally >>Birth Inj,Cong. Infection
Postnatally >> Exogenous Toxins (lead..)
Cell phone Exposure ??
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Insecurity and maternal deprivation > marital
discord/Broken homes or single parent
families (death &Traveling of one parent)
Parent by their behavior act as bad
model>copying of bad behavior
Mishandling of fear
Fear of children about organic diseases
Inconsistency of disciplinary measures
The cause of E/B disorders lies usually with
the parents rather than the child
Classification
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Sleep D
Excretory D
Speech D
Psychomotor D
Risky or Social D
Others
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Recurrent Abdominal Pain
Bed wetting-N. Enuresis-Refusal to go to toilet
Soiling of the bed (Encopresis)
Food Refusal
Nail Biting/Thumb Sucking (> 3 y &<3Y could be
accepted)
Withdrawn and regressed behavior >Autism
Hyper active Attention Deficit D
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Temper tantrum & Defiant (Disobeying) behavior
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Bullying
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School Phobia/School Truancy
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Speech problems /Stammering/Stuttering
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Sleeping problems>>refusal to go to bed / Sleeping with
parents /Night M/N Terrors/ Waking at night…..
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Head Rolling/Banging /Tic
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Conduct Disorder- Risky B more in adolescents
EXPERMINTATION
setting, automobiles
>>stealing,
Masturbation, drug, fire
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Anxiety Disorders (PtSD,Phobias,..)
OCD
Depressive disorders
Serious problems as Bipolar Disorder
& Schizophrenia
Serious Disturbances
Deliberate destructive B
(May indicate hostile relation, low self esteem)
Running off from home
Marked disturbance in function
(no obvious cause)
Repeated aggressive B
(in all settings after age 5Y)
Deliberate self-harm
Repeated fire-setting
Age-inappropriate sexual Behavior
(May indicate sexual abuse)
“You cannot make a diagnosis of mental disorder
without an extensive history that goes into all
aspects of a patient’s life”
Interview and history taking
What does your child do that make you say he is
Aggressive?
When did such behavior start?
What is the context of the behavior? What else is
happening ..?
Do these behaviors affect your child's ability to get
along with peers? achieve at school? participate in
age-appropriate activities such as sport ?
Physical Examination
If we go through this process, it will
lead to early and definite diagnosis of
EB disorder.
Consultation Skill
is the key in the assessment
of child with suspected EB disorder
W o rl d H e a l th O rg a n i za ti o n 's cl a ssi fi ca ti o n o f m e n ta l d i so rd e rs i n p rim a ry h e a l th
c a re
= = = = = == = = == = = = == = = == = = = == = = == = = == = = = == = = == = = == = = = == = = == = = == = = = == = = == = = = == = = == = = == = = = == = = == = = == = =
O rg a n ic D
FOO
F 05
M o o d , s tre s s re la te d, a n d a n x ie ty D
D e m e n t ia
F 32
D e p re s s io n
F 50
D e liriu m
F 40
P h o b ic d is o r d e r
F 51
Sle e p D
F 4 1 .0
P an ic d is o r d e r
F 52
Se xu a l D
P s y c ho a c t iv e s ubs ta nc e us e
F 4 1 .1
F 4 1 .2
FI
F 11
F 1 7 .1
p hy s io lo g ic a l D
G e n er a liz e d a n x iet y
M ixe d a n xie t y an d d e p re s s io n
A lc o h o l u s e d is o r d e r
F 43
A d ju s t m e n t d is o r d e
D r u g u s e d is o rd e r
F 44
D is s o c ia t iv e d is o r d e r
T o b acco u s e
F 45
F 48
E at in g d is o r d e rs
U n e xp la in e d s o m a t ic co m p la in t s
N e u ra s t h en ia
= = = = = == = = == = = = == = = == = = = == = = == = = == = = = == = = == = = == = = = == = = == = = == = = = == = = == = = = == = = == = = == = = = == = = == = = ==
P s y c ho t ic dis o r d e rs
F 20
C h ro n ic p sy c h o t ic d is o r d e r
F 23
A c u t e p sy c h o t ic d is o r d e r
F 31
B ip o la r d is o rd e r ,
D e ve lo p m e nt dis o rde rs
F 70
M en t a l re t a rd a t io n
D is o rde rs o f c h il d ho o d
F 90
H y p e r k in e t ic d is o r d e r
F 91
C o n d u c t d is o r d e r
F 98
E n u r e s is
= = = = = == = = == = = = == = = == = = = == = = == = = == = = = == = = == = = == = = = == = = == = = == = = = == = = == = = = == = = == = = == = = = == = = == = = == = =
Non pharmacological
Therapy
Pharmacological
(Biological) therapy
Non pharmacological T
Remember
There is no Magic RX that solve the
problem of the child
Non pharmacological T
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Supportive or minor( Psychotherapy)
Behavioral therapy
# Reinforcement
# Desensitization
# Flooding
# Modeling
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Family therapy
# Family therapy when a child or adolescent is the patient.
Non pharmacological T
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Supportive
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or minor( Psychotherapy)
Explanation
Guidance
Understanding
Keep empathy
Non pharmacological T
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Behavioral therapy
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First consider methods of prevention
Explore ABC
• Antecedents of the behavior
• Details of behavior itself
• Consequences of that behavior
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Identify probable causes and deal with
Focus on rewarding appropriate behavior
Check that any rewards really and desired
Avoid punishment as possible as you can (due)
Promote behavior that incompatible with unwanted behavior
Close supervision
Keep sense of humor
Consider the tailored
Approach according to the
Existing Emotional Problem
There are some Practical
Rules of Relevance
The 1st Rule
Identify source of stress and correct it
The 2nd Rule
Enhance self –esteem
Praise, reinforcement of positive behavior and
reward once needed
???????
The 3rd Rule
Clarifying and sharing rules and standard at the
level of the home with the child
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The parent are uncooperative and have not complied
with treatment
Hidden factors are existing that have been missed
• Bullying
• Academic failure
• Parental relationship problems
• Sexual abuse
• Problems with peers
The treatment was too short or too superficial
The wrong treatment was used
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Parent, school and peers have influence
on continuity or recurrence of the EBD
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Emotional BD that arise in 1st 4-5 years
usually do not continue except if the child
failed to gain control on the problem
???????
Myth
>>>> Crying is good for babies
The sound Principle
The baby becomes a barometer of the mother's feeling.
If the mother is happy and relaxed her baby will
be peaceful.
If the mother is anxious her baby is likely to
reflect this anxiety and to cry excessively.
Telling the mother that, the cause of crying is colic will make
it more difficult for mother to understand the real reason.
The crying baby should be picked up and comforted immediately
by searching for the reason of crying
Myth >>
Once a baby is allowed to sleep in the parental bed he
will never leave it
The sound Principle
This vision ignores the fact that babies want to grow up.
Children learn to be independent by being allowed to be
dependent for as long as they need.
Myth >>
measures”
Physical punishment is a good as disciplinary
The sound Principle
Absolute Physical punishment for children is a mistake
This form of aggression should not be learned from
parent.
The children will tolerate this form of punishment and
approve it with their friends later on.
The safest and most effective punishment is the
removal of a privilege, sweet or pocket money,…
The sound Principle
Consistent
Disciplinary Measures
( Father # Mother)
Why??
The child is doing good business
The sound Principle
Do
not compare the child with
others
!!!!
Compare the child with him/her self
Parent as therapeutic agents
!!!!
This is the responsibility of
physician to share this vision with
the parents
Teachers as therapeutic agents
>> school-age
!!!!
This is the responsibility of
physician and parent to organize
for..
Physician as therapeutic agent
!!!!
By applying principles of FM
DPR, Communication,……
Objectives
By the end of the session the trainee will be able to :-
•
Identify difference between Mental Health and Mental
Disorder!! What do you mean??
•
Define burden of the problem of Mental Disorders !!Why
Mental Disorders?
•
Identify normal development of the child
•
Define etiology of EB Disorders
•
Identify different forms of EBDs
•
Classify Mental Disorders (ICD-10-PHC & DSM-4)
•
Identify the different treatment modalities of EBD
!!Management plan
•
Identify causes of failure of treatment #Referral !!!
•
Prognosis of EMD
•
Identify preventive measures for EBD!! Preventive Issues for
EBD