Child and adolescent psychiatry: general aspects of care

Child and adolescent psychiatry is a broad dis­cipline relevant to any health professional who has regular contact with young people. Childhood emotional, behavioural, and developmental prob­lems are common, especially in children with other medical or social difficulties. This chapter aims to provide an approach to child mental health diffi­culties, while Chapter 32 deals with common and/ or important psychiatric disorders that are specific to childhood. You may find it helpful to revise some basic child development— this can be found in any general paediatrics text (see ‘Further reading’). An overview of the differences between child and adult psychiatry is shown in Box 17.1. As in adult psychiatry, diagnosis of psychiatric dis­orders often relies on the clinician being able to recog­nize variants of and the limits of normal behaviour and emotions. In children, problems should be classified as either a delay in, or a deviation from, the usual pattern of development. Sometimes problems are due to an excess of what is an inherently normal characteristic in young people (e.g. anger in oppositional defiance disorder), rather than a new phenomenon (e.g. hallu­cinations or self- harm) as is frequently seen in adults. There are four types of symptoms that typically pre­sent to child and adolescent psychiatry services: … 1 Emotional symptoms: anxiety, fears, obsessions, mood, sleep, appetite, somatization. 2 Behavioural disorders: defiant behaviour, aggression, antisocial behaviour, eating disorders. 3 Developmental delays: motor, speech, play, attention, bladder/ bowels, reading, writing and maths. 4 Relationship difficulties with other children or adults…. There will also be other presenting complaints which fit the usual presentation of an adult disorder (e.g. mania, psychosis), and these are classified as they would be in an adult. Occasionally, there will also be a situ­ation where the child is healthy, but the problem is ei­ther a parental illness, or abuse of the child by an adult. Learning disorders are covered in Chapter 19. Table 17.1 outlines specific psychiatric conditions diagnosed at less than 18 years, and Box 17.2 lists general psychiatric conditions that are also commonly found in children.

Forensic Psychiatric Analysis of Juvenile Delinquency and Sexual Abuse Perspective

This chapter describes how, although, sexual offenders commit sexual offences as a source of pleasure to themselves, sometimes with harm intended, the vast majority of victims endure long-lasting adverse impacts that affect them in all aspects of life. Juvenile delinquency has become much more prevalent, or more so known in the age of digital media and enhanced communication. Thus, the rapid evolvement and revolutionized media has made the issue more known to the communities and society, as the families and stakeholders seek for reasons behind the rise of sexual assaults, and possible strategies to tackle the pandemic. Although, it has often been perceived as a maladaptive and learning related behavior, literature suggests that majority of the juvenile delinquents suffer from psychological and psychiatric disorders, from mild, moderate to severe psychiatric disorders. The most prevalent disorders found were: ADHD, substance abuse disorder, posttraumatic stress disorder (PTSD), depression, conduct disorder, FASD and oppositional defiance disorder to be the most prevalent among juvenile delinquents.

Forensic Psychiatric Analysis of Juvenile Delinquency and Sexual Abuse Perspective

This chapter describes how, although, sexual offenders commit sexual offences as a source of pleasure to themselves, sometimes with harm intended, the vast majority of victims endure long-lasting adverse impacts that affect them in all aspects of life. Juvenile delinquency has become much more prevalent, or more so known in the age of digital media and enhanced communication. Thus, the rapid evolvement and revolutionized media has made the issue more known to the communities and society, as the families and stakeholders seek for reasons behind the rise of sexual assaults, and possible strategies to tackle the pandemic. Although, it has often been perceived as a maladaptive and learning related behavior, literature suggests that majority of the juvenile delinquents suffer from psychological and psychiatric disorders, from mild, moderate to severe psychiatric disorders. The most prevalent disorders found were: ADHD, substance abuse disorder, posttraumatic stress disorder (PTSD), depression, conduct disorder, FASD and oppositional defiance disorder to be the most prevalent among juvenile delinquents.

A cross sectional study of psychiatric morbidity in juvenile boys admitted in an observation home

Background: It is estimated that 10-20% of children and adolescents are affected annually by psychiatric problems. Studies in several countries across three continents have repeatedly shown that young offenders have higher rates of psychiatric morbidity than youths in the community. Given the growth of juvenile delinquent population, epidemiologic data on their psychiatric evaluation is becoming increasingly important. Thus, to study the psychiatric morbidity in juvenile delinquent boys in an observation home was undertaken.Methods: This cross sectional study was conducted in an observation home for boys. Study was approved by the institutional ethics committee. Prior to conducting the study, informed written consent was sought from the superintendent of observation home for boys. The study sample consists of 50 boys from the observation home aged between 6-16 years. Boys from observation home for whom responsible legal authority gave permission were included in the study.Results: Prevalence of individual psychiatric disorders was as follows: conduct disorder 23 (46%), anxiety disorder 05(10%), oppositional defiance disorder 04 (08%), mild mental retardation 03 (06%), depression 02 (04%), psychosis 01(02%), adjustment disorder 01(02%), disorders of emotions and conduct 01 (02%). In our study prevalence of psychiatric disorder was more common in juveniles under conflict of law (19 out of 20) than juveniles under care and protection (25 out of 30).Conclusions: Initial screening of juveniles in observation home by expert mental health care professionals is needed for the rational management of psychiatric morbidity and enhancement of their development towards productive adulthood and productive integration into the general society.

The neurobiology of oppositional defiant disorder and conduct disorder: Altered functioning in three mental domains

This review discusses neurobiological studies of oppositional defiant disorder and conduct disorder within the conceptual framework of three interrelated mental domains: punishment processing, reward processing, and cognitive control. First, impaired fear conditioning, reduced cortisol reactivity to stress, amygdala hyporeactivity to negative stimuli, and altered serotonin and noradrenaline neurotransmission suggest low punishment sensitivity, which may compromise the ability of children and adolescents to make associations between inappropriate behaviors and forthcoming punishments. Second, sympathetic nervous system hyporeactivity to incentives, low basal heart rate associated with sensation seeking, orbitofrontal cortex hyporeactiviy to reward, and altered dopamine functioning suggest a hyposensitivity to reward. The associated unpleasant emotional state may make children and adolescents prone to sensation-seeking behavior such as rule breaking, delinquency, and substance abuse. Third, impairments in executive functions, especially when motivational factors are involved, as well as structural deficits and impaired functioning of the paralimbic system encompassing the orbitofrontal and cingulate cortex, suggest impaired cognitive control over emotional behavior. In the discussion we argue that more insight into the neurobiology of oppositional defiance disorder and conduct disorder may be obtained by studying these disorders separately and by paying attention to the heterogeneity of symptoms within each disorder.