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Psychiatric treatments of child and adolescent mental disorders.

Psychiatric treatments of child and adolescent mental disorders. Dr. Oğuzhan Zahmacıoğlu. AIMS. a) Learning about the importance of psychotherapy in child and adolescent pscyhiatry.

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Psychiatric treatments of child and adolescent mental disorders.

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  1. Psychiatric treatments of child and adolescent mental disorders. Dr. Oğuzhan Zahmacıoğlu

  2. AIMS • a)Learning about the importance of psychotherapy in child and adolescent pscyhiatry. • b)Learning about family therapy, behavioral approaches to child mental disorders, cognitive therapy, play therapy and family guidance. • c)Understanding the basic principles of drug treatments in child and adolescent pscyhiatry. • d)Learning about the pharmacologic agents that are used for child mental health disorders.

  3. Classification of Treatments I.PSYCHOTHERAPIES: • Individual therapies (play therapy, cognitive therapiy, behavioral therapies) • Family therapy • Group therapies • Psychoeducational approaches II. Drug treatmens

  4. General Principles • 1. Combined treatment approach • 2. Close monitorization of the process • 3. Good cooperation with family needed • 4. Cooperation with school

  5. General Principles of Pharmacological Treatments • 1. Plan focusing on the target symptom. • 2. As an adjunct to psychosocial treatments. • 3. Close monitorization of target symptom. • 4. Side effects should be kept in mind. • 5. Consider the risk on the developmental process. • 6. Different responses compared to adults may arise.

  6. Pharmacokinetic and pharmacodynamic differences between adults and children • 1. In children absorbtion may be faster. • 2. Body composition, fat ratio differences. • 3. Liver metabolism rate is faster • 4. Glomerular filtration of lithium is faster. • 5. Higher concentration of Dı-D2 receptors. • 6. NA system underdeveloped

  7. Main pharmacologic agents • Psychostimulants • Antidepressants • Antipsychotics • Anxiolitic drugs • Antihistaminics • Anticonvulsants

  8. Psychostimulants • Indications: ADHD • Metilphenidate (RİTALİN, CONCERTA) • Amphematime group, • Dosage: 5-60 mg/g , • Side effects: insomnia, loss of appetite, feelings of unesiness, tremor, hypertention, tachicardia, crying spells • Contrindications: tics, dyskinezia, psychotic reactions, epilepsy

  9. Antidepressants I. Tricyclics: İmipramine, clomipramine II. Selektive serotonine reuptake inhibitors: Fluvoxamine, fluoxetine, sertralin

  10. Antipsychotics • 1. Agitations, aggressive behaviors associated with PDD;MR, • 2. Tics, Tourette’s Disorder. • 3. Conduct disorder • 4. Schizophrenic disorder, bipolar disorders

  11. Tipik Antipsikotikler

  12. Atipik Antipsikotikler

  13. Trisiklik antidepresanlar

  14. SSRI

  15. Antihistaminics • Difenhidramin : 25 mg/g (max: 5mg/kg/g) • Hydroxizin: Max 50 mg/g before 6y • max 100 mg/g after 6. • Indications: insomnia, irritability, anxiety

  16. Anticonvulsants • Carbamazepine: impuls control disorders Anger spells, aggressive behavior: 200-600 mg/g Side effects: dizziness, incoordination, aplastic anemia, agranulositosis. • Valproik ascid: angry spells, behavioral disorders, disruptive behavior, manic attack: 10-15 mg/kg/g Side effects: Sedation, nausea, vomiting, tremor, increased appetite, hepatotoxicity, obesity.

  17. Psychotherapies • Play therapy • Behavioral therapies • Family therapy • Group therapies • Cognitive therapy

  18. Play therapy • Can be used between 2,5-14 yrs.of age • Hypothesis:”What the child plays reflects what is in his/her mind”!

  19. Behavior Therapy • 1. Simple conditioning (Conduct problems, eating disorders, hyperactivity, enuresis, encopresis) 2. Systematic Desensitization (Anxiety disorders and phobias) 3. Exposure (OCD) 4. Social skills training

  20. Family Therapy • Takes the family system as a whole. • In child psychiatry family assessment is a must. • Most of the time child and family therapy is done together.

  21. Cognitive therapies • Most helpful in adolescent period: Depression, Identity disorders Conduct disorders Impulse control disorders

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