Child Psychiatry In Cairo university

1. Child Psychiatry In Cairo university Ola Shahin Professor of Psychiatry Cairo University Egypt

5. CSPM

6. Cairo University • Started ,1968 , Aboulrish Pediatric hospital (once\week 1-2pm) • Establshed 1997 center for Social & Preventive medicine daily from9am-1pm.

7. Out patient clinic 900 patient/month. • It serves a catchment's area of <450, 000 population, in addition to those patients referred from the nearby governorates (Giza , Banysueif , Elfayoum ..etc) • Coming directly or as Referrals from other pediatric departments

8. Cairo University OPC • 2 clinics • 1 room for the nurses • 2 rooms for psychological assessment • Play room for different activities

9. Staff senior staff. 6 psychologist. 3 social workers 2 junior staff 2 Nurses 3 Resident 2

10. Services • Community services e.g home & school visits • Field visits for orphanages - Detection of mental problems - Referral for psychiatric intervention - Training of care givers for parenting skills • Liaison psychiatric services that are conducted to all pediatric departments in the pediatric hospital department

11. Training • Junior Residents (General Psychiatry; Phoniatrics) • Primary healthcare physicians for early detection • Pediatricians( Postgraduate, Detection &referral) • Training for university student in faculty of art Psychology & Faculty of social services faculty of Kg.

12. Scientific • Teaching Postgraduate . (Clinical psychologists, Pediatricians, Phoniatricis, nursing collage) • Teaching for undergraduate • Scientific Researches • Clinical conferences both national and international • Workshops

13. workshops • PDD • Epilepsy • Play Therapy • Group therapy • SLD • Family Education • Mental Health in Primary care • Liason Psychiatry • Family education • Externalising disorders • SLDs

14. 4584 New 8044 follow up 3741 Referrals

16. Developmental 1760 (38.4%) • ADHD 541 30.7% • MR 536 30.5% • Communication 256 14.5% • SLD 220 12.5% • PDD 92 5.2% • Autism 40 2.2 % • Epilepsy 5%

17. Most disabilities with clear medical basis are recognized by pediatrician or parents soon after birth.or during preschool age. • In contrast , the majority of children are initially referred for evaluation by the school teacher or parents because of severe and chronic underachievement or behavioral problems.

18. There are evidence that the prevalence of some disabilities varies with age. • The high incidence disabilities such as learning ,speech and language disablities occur primarily at the mild level. • The mild disabilities exist on the broad continum in which there are no clear demarcation between those who have and those who do not have the disability.

19. Problems of Disabilities • Stigma to the child and the family • No. of deficits • Severity of discrepancies • Complexities of intervention • Intensity of intervention • They are at risk for maltreatment • They are more at risk for injury

20. Many children will always need supervision for tasks that put them into situation of injury risk eg: • Bathing, swimming, fire risk reduction…etc , risk of fall for mobile children, wheel chair, risk of maltreatment, • Educational efforts focused on safety should include; pediatrician, rehabilitation therapist, social worker, teacher and parents

21. Projects 1-Protection of youth from addiction (NCMC) 2- Street children 2-Child-Mother caretaker Friendly orphanages 3-E- learning Network ( University Collaboration) 4-Early Detection and intervention of inborn errors of metabolism

22. Mental Health in primary care units ( British council) • Finish Mental Health programme in Egypt • Institutional Collaboration between Child Psychiatry Units in Oulu University, Finland, and Abbassia Mental Hospital and Cairo University, Egypt

23. Objectives • To exchange experiences between Child Psychiatry Units in Oulu University, Abbassia Mental Hospital and Cairo University. • To increase knowledge of childhood psychiatric problems in different culture in order to be able to treat them in proper way, culture-sensitive way. • Conjoint research work. • To improve the standard of psychiatric care delivered to children in Egypt. • To build a multidisciplinary teamwork oriented with different treatment modalities.

24. Outcomes • Sponsored observerships were provided for Egyptian doctors to visit Oulu University Child Psychiatry Department and affiliated child mental health centres: • In 2006: • A Professor from Cairo University • Senior Doctor from Abbassia Mental Hospital • Oral Presentation ‘Child and Adolescent Psychiatry Services in Egypt and Poster ‘Child and Adolescent Psychiatry in Cairo University • Oral Presentation ‘Child and Adolescent Psychiatry in Abbassia Mental Hospital’ in Oulu University Hospital and Poster ‘Child and Adolescent Psychiatry in Abbassia Mental Hospital

25. Outcomes (Cont.) • Sponsored observerships were provided for Egyptian doctors to visit Oulu University Child Psychiatry Department and affiliated child mental health centres: • In 2007: • A professor from Cairo University • Two junior doctors - Cairo University and Abbassia Mental Hospital(5 weeks) • Oral Presentation

26. Outcomes (Cont.) • Training courses were held in Egypt: • In Child and Adolescent Psychiatry by a Professor of Child Psychiatry from Oulu University in 2006 and 2007. (2 weeks each) • In Speech and Music Therapy by a Speech Therapist from Oulu in 2007. (2 courses, one week each) • In Special Education by a Special Educator from Oulu in 2007. (2 courses, one week each)

27. Outcomes (Cont.) • Training on Autism Diagnostic Interview Revised (ADI-R) in 2007 and now we translated it into Arabic to be later used on a wider scale in all Arabic speaking countries. • Monthly telematic consultations are held between Oulu University and Abbassia Mental Hospital.

28. Outcomes (Cont.) • In Cairo University Hospital: • Establishment of a Specialized Clinic for Autism Spectrum Disorder. • Enrichment of the Learning Disabilities Clinic (tools – new concepts of intervention). • Child Psychiatry services are extended to include other underprivileged governorates in Egypt as Assuit, Khanka, Port Said and Helwan.

29. Outcomes (Cont.) • Research activity represented by : • A PhD thesis - in progress - Social Interaction in Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) • M. Sc. thesis – in progress – Gender Differences in ASD Cultural Differences

30. A clinic For Autism • Any case of delayed language • Structured Clinical interview • Language asessment • IQ • CARS test • ADI-R

31. Historically, the diagnosis of autism has been based on clinical observations and intuitions rather than through the use of standardized diagnostic protocols. • This necessitated extensive training of professionals in autism and related PDDs to make accurate diagnoses. • Standardized diagnostic tools have been developed within the past 10 to 15 yet diagnosing autism continues to rely on direct clinical impressions in 65% of cases.

32. Pitfalls in diagnosis • Age of child at diagnosis • Changing of the symptoms over time • Symptom overlap of ASD • Not all the symptoms are present at the same time • Overshadow by another clinical problem • Co morbidity • Tool used in diagnosis

33. Negligence of symptoms as a normal developmental variant • Misdiagnosis as medical or developmental problem • Lack of experience • Clinical skill training • Underestimation of parental complaint • Over diagnosis due to parental over concern

34. Negligence of symptoms as a normal developmental variant • Misdiagnosis as medical or developmental problem • Lack of experience • Clinical skill training • Underestimation of parental complaint • Over diagnosis due to parental over concern

35. Measurement tools • Although there are several instruments that reliably and validly differentiate between PDD spectrum disorders and non spectrum disorders, none of the diagnostic instruments adequately differentiate between the different subtypes of PDD.

36. conclusions 1. Autism is not a new disorder.  2. Autism is a group of disorders, not a single condition.  3. There is a rise in incidence of autism, in part an expansion of diagnostic criteria, and in part an actual increase; but it is not an 'epidemic'. 

37. 4. Since autism is not a single disease, there is not one, single cause; possibilities include genetic, environmental, immunological, metabolical and neurological factors, or some interaction thereof.  

38. 5. A number of studies and other factors point away from vaccines, either from preservatives or immunologic reactions, being a cause of autism; further studies should provide definitive answers to that polarizing question

39. 6. Other environmental agents or pollutants  (heavy metals, BPA. PBCs) deserve further study in pregnancy, infants and childhood.  7. The list of empirical interventions and treatments is a lengthy and diverse one, given the fact there are no definitive, demonstrated causes of autism. 

40.  The beginning of wisdom is to call things by their right name; when the specific sub-groups of autism, and their varying causes are identified, then definitive treatment and preventative strategies can emerge as elsewhere in medicine.

41. However, intensive behavioural interventions, formal or informal, in schools and/or homes, do show effectiveness in many autistic children.  The earlier they are applied, the better the outcome. 

42. Needs • Increase the awareness of primary care physicians and pediatricians • Training on early detection using brief tools M-CHAT • Referral system multi centers eg Cairo University , Alazhar university, Almansoura University… • Survey prevalence study • Evaluation of referred cases( Clinical interview FH , Psychological assessment,Lab sampling  

43. Training of psychiatrists or psychologists on the use of ADIR (10 from agreed upon centers) • Development of a lab for the suggested immunological and genetic studies( NRC Cairo, and the Immunolgy Lab at Almansoura • Implementation of services and development of Training on intervention programes

44. Cont. • This will agree with the objectives of the Presidential WPA program on global child Mental Health, 2005 who stated that;there are 3 tasks forces: 1- Task force on Awareness. 2- Task force on Primary prevention. 3-Task force on service development and management.

45. Ministry Of Health Facilities • Mental Hospitals 14 • Urban Health centers 186 • Health offices 439 • MOH Centers 229 • School Health Centers 8 • School Health units (Insurance) 48 • Community clinics 104 • Rural Health Units 2354

46. Primary Health Care Units • 4880. • Equally distributed. • Birth → 18. • Basic medical package including mental health problems.

47. Cont. • One in 4 children seen by the GP have a psychiatric disorder and most parents with an emotionally disturbed children prefer to take them to a GP or other pediatrician other than a psychiatric clinic.

48. Thank you

49. Though some can benefit from psychiatric intervention they are all labeled to have scholastic underachievement and may pass unidentified , leave the school undiagnosed with no management.

50. Conclusion • Child & Adolescent psychiatry in Egypt is growing during the last decades. • Many efforts are existing and are developing in a trial to extend the services to cover the needs of the whole population.