兒童少年精神病學(xué)英文第1頁(yè)/共71頁(yè)第2頁(yè)/共71頁(yè)OutlinePrefaceofChildandAdolescentsPsychiatryMentalRetardationAttentionDeficitHyperactivityDisorder第3頁(yè)/共71頁(yè)DefinitionChildandAdolescentsPsychiatryistheacademicandclinicaldisciplinewhichstudyingandcaringforchildrenandadolescentswithEmotionaldisordersbehavioraldisordersdevelopmentaldisorders

第4頁(yè)/共71頁(yè)Thefieldofchildandadolescentpsychiatryisquiteyoung.1867MaudsleyH.firstdescribedinsanityofearlylifeinhisbook《Physiolgyandpathologyofmind》1950’formaltrainingprogramsinchildpsychiatrybecomepopularinAmerican1970’quickdevelopment

第5頁(yè)/共71頁(yè)Thesocialsciences(socialandcommunalfactors,familyfunctioning,parent-childrelations)ManybasicsciencecontributetoknowledgerelevantchildpsychiatryThebiologicalscience(braindevelopment)Thechilddevelopmentalpsychology第6頁(yè)/共71頁(yè)EpidemiologyChildandadolescentmentalhealthisanessentialpartofoverallhealth.

World-wideupto20%ofchildrenandadolescentssufferfromadisablingmentalillness(WHR,2000).World-widesuicideisthe3rdleadingcauseofdeathamongadolescents(WHR2000).Majordepressivedisorder(MDD)oftenhasanonsetinadolescence,acrossdiversecountries,andisassociatedwithsubstantialpsychosocialimpairmentandriskofsuicide(Weissman,1999)第7頁(yè)/共71頁(yè)Epidemiology

XINRE(1992)CBCL12.97%LiXR(1993)DSM-III-R14.89%Itmeansthatthereare46770000childrenneedhelpinChina.第8頁(yè)/共71頁(yè)P(yáng)ooroutcomesLightandBailey(1998)reportthatlongitudinalstudiesfindthatabouthalfthechildrenwithpsychiatricdisordersexhibitthesameorsimilardisordersyearslater.Conductdisorderrelatedbehaviorstendtopersistentintoadolescenceandadultlifethroughdrugabuse,juveniledelinquency,adultcrime,antisocialbehavior,maritalproblems,pooremployeerelations,unemployment,interpersonalproblems,andpoorphysicalhealth(Patterson,DeBaryshe,&Ramsey,1989).第9頁(yè)/共71頁(yè)P(yáng)resentstatesofchildmentalhealthMostScandinaviacountries,manyEuropeancountriesandAmerican:aboutonechildpsychiatristforevery50,000peopleinthepopulationInChina:lessthan100childpsychiatristthroughoutthecountry第10頁(yè)/共71頁(yè)P(yáng)resentstatesofchildmentalhealth1950s-1970s,afewdoctorsworkinginthechildpsychiatricclinicinbigcities.ThefirstChildpsychiatryclinicinChinawasestablishedinNanjingbyDr.TaoGuotai.

ChineseChildMentalHealthBoardofChineseMentalHealthAssociationwasestablishedin1989第11頁(yè)/共71頁(yè)Now,manychildpsychiatryresearchinstituteshavebeenbuilt,includingclinics,wardsandcaringcentersforchildrenandadolescentsinBeijing,Nanjing,Shanghai,Changsha,Chengdu,Fuzhou,Jinan,andsoon.Childmentalhealthclinicshavealsobeenbuiltinmorecities.第12頁(yè)/共71頁(yè)SocialneedisincreasingEmotionalquotient(EQ,GarduerHandSaloveyP.)Theabilitytoaccurateappraisalandexpressionofemotionsinoneselfandotherstoregulateemotioninawaythatenhanceslivingtorecognizetheconsensuallyagreeduponemotionalqualitiesofobjectsintheenvironment.TheachievementofonedependuponIQ20%EQ80%第13頁(yè)/共71頁(yè)TheWHOSchoolContest,heldaspartofWorldHealthDay2001whichhadthetheme“StopExclusion:DaretoCare”ChinesePresidentJiangZe-mininhislettertoDrBlundtland,thesecretary-generalofWHO,hasemphasizedChinesegovernmentwillmobilizethewholesocietytocreateasuitableenvironmentforpeoplewithmentaldisorderstogobacksociety.第14頁(yè)/共71頁(yè)ClassificationWHO(1992):InternationalClassificationofDisease,TenEdition(ICD-10)APA(1994):DiagnosticandStatisticalManualofMentalDisorders,FourthEdition(DSM-IV)第15頁(yè)/共71頁(yè)ChineseClassificationofMentalDisorders-Version3(CCMD-3)2000

7.Mentalretardation,anddisorderofpsychologicaldevelopmentalwithonsetusuallyoccurringinchildhoodandadolescence

8.Hyperkinetic,Conduct,andEmotionaldisorderswithonsetusuallyoccurringinchildandadolescence第16頁(yè)/共71頁(yè)Classification71.1Specificspeecharticulationdisorder71.2Expressivelanguagedisorder71.3Receptivelanguagedisorder71.4Acquiredaphasiawithepilepsy71.9Otherorunspecifieddevelopmentaldisordersofspeechandlanguage

70.Mentalretardation

71.Developmantaldisorderofspeechandlanguage第17頁(yè)/共71頁(yè)Classification72.1Specificreadingdisorder72.2Specificspellingdisorder72.3Specificdisorderofarithmeticalskills

72Specificdevelopmentaldisordersofscholasticskills第18頁(yè)/共71頁(yè)Classification72.4Mixeddisorderofscholasticskills72.9Otherorunspecifieddevelopmentaldisordersofscholasticskills

73Specificdevelopmentaldisorderofmotorskills

74Mixedspecifieddevelopmentaldisorders第19頁(yè)/共71頁(yè)Classification75.1Childhoodautism75.2Atypicalautism75.3Rett’ssyndrome75.4Childhooddisintegrativedisorder75.5Asperger’ssyndrome75.9OtherorunspecifiedPervasivedevelopmentaldisorders75Pervasivedevelopmentaldisorders第20頁(yè)/共71頁(yè)Classification80.1Attentiondeficitandhyperactivitydisorder80.2Hyperkineticconductdisorder80.9Otherorunspecifiedhyperkineticdisorder

80.Hyperkineticdisorder第21頁(yè)/共71頁(yè)Classification81.1Dissocialconductdisorder81.2Oppositionaldefiantdisorder81.9Otherorunspecifiedconductdisorder

81Conductdisorders

82Mixeddisordersofconductandemotions第22頁(yè)/共71頁(yè)83.1Separationanxietydisorderofchildhood

83.Emotionaldisorderswithonsetspecifictochildhood

83.2Phobiaanxietydisorderofchildhood

第23頁(yè)/共71頁(yè)83.3Socialanxietydisorderofchildhood

83.Emotionaldisorderswithonsetspecifictochildhood

83.91Generalanxietywithonsetspecifictochildhood

第24頁(yè)/共71頁(yè)Classification84.1Electivemutism84.2Reactiveattachmentdisorderofchildhood84.9Otherorunspecifiedchildhooddisordersofsocialfunctioning

84.Disordersofsocialfunctioningwithonsetspecifictochildhoodandadolescence

第25頁(yè)/共71頁(yè)Classification85.1Transientticdisorder85.2Chronicmotororvocalticdisorder85.3Tourette’ssyndrome85.9Otherorunspecifiedticdisorder

85.Ticdisorders第26頁(yè)/共71頁(yè)Classification86.1Nonorganicenuresis86.2Nonorganicencopresis86.3Feedingdisorderofinfancyandchildhood86.4Picaofinfancyandchildhood86.6Stuttering86Otherbehavioraldisorderswithonsetusuallyoccurringinchildhoodandadolescence

89Otherorunspecifiedchildhooddisordersofsocialfunctioning第27頁(yè)/共71頁(yè)

MentalRetardation

(MR)第28頁(yè)/共71頁(yè)Definition

Mentalretardationisaconditionofarrestedorincompletedevelopmentofthemind,whichischaracterizedbydeficitsinintelligenceandsocialadjustment.Thedisorderemergesbefore18yearsold.Thelevelofintelligenceasshowninstandardizedpsychometrictestisdefinedasbelow70,whilethescoresfrom70-85aredefinedasborderlineintelligence第29頁(yè)/共71頁(yè)

Epidemiology

WHO(1985):TheprevalenceofMRinthegeneralpopulationis4‰ofmildandsevereMR30‰(includemildMR);LiXR(1993)DSM-III-R22.2‰Morecommoninruralthanincitypopulation第30頁(yè)/共71頁(yè)

ClinicalDescription(1)TherangeofIQisfrom50to69andthepsychologicalageliesbetween9and12yearsold;(2)Pooracademicperformancewithspecificdifficultiesinreadingandwriting,whileatworkthesepatientsareonlycapableofunskilledmanualjobs;(3)Independenceinself-care;(4)Intactabilitytocommunicateatordinarylevelindailylifedespitedifficultyincommunicatingdifficultinformationinreadingandwriting

Mildmentalretardation

第31頁(yè)/共71頁(yè)

ClinicalDescription(1)TherangeofIQisfrom35to49andpsychologicalageisabout6to9yearsold;(2)Capabilityinsimplearithmeticbutnotuptoprimaryschoollevel.Thesepatientscancopesimplelaboringjobswithsimpleworkoutputandefficiency;(3)Capabilityofself-care;(4)Capabilityindailylifecommunicationatordinaryleveldespitelimitedrangeofvocabulary

Moderatementalretardation

第32頁(yè)/共71頁(yè)

ClinicalDescriptionmentalretardation(1)TherangeofIQisfrom20to34,andpsychologicalageisapproximatelybetween3and6yearsold;(2)Presenceofmarkedmotorimpairmentandotherassociateddeficitsintaskperformance;(3)Incapabilityofself-care;(4)Markeddeficitsinlanguagedevelopmentandincapabilityincommunicatingindailylife

Severementalretardation

第33頁(yè)/共71頁(yè)

ClinicalDescriptionProfoundmentalretardation(1)TherangeofIQisunder20andpsychologicalageisbelow3yearsold;(2)Completesocialdisabilitywithlackofawarenessofdangeroussituation;(3)Incapabilityinself-careandbladderorbowelcontrol;(4)Absenceofcommunicablespeech.Profoundmentalretardation

第34頁(yè)/共71頁(yè)EtiologyChromosomalaberrations Downsyndrome

Geneticdisorders第35頁(yè)/共71頁(yè)EtiologySingle-genemutations:Tuberoussclerosis,phenylketonuriaandothermetabolicdisorders

Geneticdisorders第36頁(yè)/共71頁(yè)EtiologyFragileXsyndrome

Geneticdisorders第37頁(yè)/共71頁(yè)EtiologyMalformationsyndromesPrader-Willi,Williams,andAngelmanduetomicrodeletionssyndromes

Geneticdisorders第38頁(yè)/共71頁(yè)Etiology

Maternalinfections :Congenitalrubella,HIVTeratogens:FetalalcoholsyndromeToxemia:placental prematurityinsufficiencyOther:radiation,trauma

Exposure第39頁(yè)/共71頁(yè)EtiologyEncephalitisToxins:LeadpoisoningOtherpostnatalcauses Traumasbraintumors

Postnatal Infections第40頁(yè)/共71頁(yè)EtiologyPovertyEducation

Psychosocialproblems

Unknown第41頁(yè)/共71頁(yè)DiagnosisanddifferentialdiagnosisPsychometrictestsofIntelligenceGesell:0～3yearsoldBayley:2～30monthPPVT:mornthan2yearsWISC-RC:6～16yearsoldC-WYCSI:4～6.5

yearsold

第42頁(yè)/共71頁(yè)SocialAdaptiveAbilityScaleexistingconcurrentlywithrelatedlimitationsintwoormoreofthefollowingapplicableadaptiveskillarrears:

communicationself-carehomelivingsocialskillscommunityuseself-directionhealthandsafetyfunctionalacademicsleisureandwork第43頁(yè)/共71頁(yè)

DiagnosisanddifferentialdiagnosisInmostcasesthereismentalretardationofvaryingdegreewhileinsomecasesthereareisolatedlocusofsuperiorintellectualabilityonabackgroundoflowgeneralintelligence.differentialdiagnosiswithAutism

第44頁(yè)/共71頁(yè)QualitativeimpairmentinreciprocalsocialinteractionsAbnormalitiesinlanguagedevelopmentRestricted,repetitive,andstereotypedpatternsofbehavior,interests,andactivitiesdifferentialdiagnosiswithAutism

第45頁(yè)/共71頁(yè)

OnsetafteranormalperiodhallucinationparanoiabehaviordisturbancedifferentialdiagnosiswithSchizophrenia

第46頁(yè)/共71頁(yè)TreatmentTrainingandrehabilitationTreatmentaimforcauseofdiseaseTreatmentaimforsymptoms第47頁(yè)/共71頁(yè)Attentiondeficithyperactivitydisorder

(ADHD)

第48頁(yè)/共71頁(yè)

ADHDisoneofthemostimportdisordersthatChildandadolescentspsychiatriststreat.Itishighlyprevalent,makingupasmuchas50%ofchildpsychiatryclinicpopulations.Untreated,itpredisposesachildtopsychiatricandsocialpathologyinlaterlife.ThecoresymptomsofADHDistheinabilitytofocusattention,difficultymaintainingcontroloverimpulsivebehavior,andageneralizedhyperactivityDefinition第49頁(yè)/共71頁(yè)EpidemiologyTheprevalenceofADHDinthegeneralpopulationisapproximarely3%to10%.LiXR(1993)DSM-III-R6.04%Morecommoninboysthaningirlsataratioof9:1inclinicalsample4:1inepidemiologicalsamples

第50頁(yè)/共71頁(yè)ClinicalDescription

distractablebyenviernmentstimuliwhileconcentrating;failuretomaintainpersistenceattentionincalss;frequentomissionsofhomework;lackofpersistence,movefromoneactivitytoanother

Inattention第51頁(yè)/共71頁(yè)ClinicalDescription

motorrestlessnessandfidgety,run,jump,climbandgooffseatswhenthesituationdoesnotpermitasplayingorwhisperinginclassdifficultiesinabidingbyrulesingamesandimpatiencetowaitforone’sownturn;

Hyperactivity第52頁(yè)/共71頁(yè)ClinicalDescription

intrudingonorinterruptingother’sactivitiesteaseotherchildrenandtogetintroublesbeingeasilyfrustrantedandimpulsivewithemotionaldisplaylackofawarenessofriskandhazards.

Impulsivity

第53頁(yè)/共71頁(yè)Comorbidity

Learningdisorders(LD):10%to92%

Oppositionaldefiantdisorder(ODD):40to65%

Conductdisorder(CD):42.7%to

56%

第54頁(yè)/共71頁(yè)ClinicalDescription

ResultedinmarkedimpairmentinsocialfunctioningintermsofacademicperformanceandinterpersonalrelationshipEarlyonsetusuallybefore7yearsofage第55頁(yè)/共71頁(yè)EtiologyCatecholaminebnormalitiesBlood,urineandCSF:lowdopamineandnorepinephrineturnoverInteractionbetweenserotoninandcatecholaminesystems

Biochemistry第56頁(yè)/共71頁(yè)EtiologyHeritabilityisestimatedtobetween0.55to0.92Twinstudyconcordance51%inmonozygotictwins33%indizygotictwins;

Genetic第57頁(yè)/共71頁(yè)