Prevention and Treatment in Child Psychiatry

1. Prevention and Treatment in Child Psychiatry Dr Finbarr O’Leary Consultant Child and Adolescent Psychiatrist

2. Multi – Axial Classification • 1. psychiatric syndrome • 2. specific developmental delays • 3. intelligence • 4. medical conditions • 5. psychosocial situations

3. prevention 1. Primary prevention stop the disorder occurring. remove the cause 2. Secondary prevention identify the disorder at onset prevent extension 3. Tertiary prevention limit disability from an established disorder

4. prevention 1. Primary prevention health promotion disease prevention 2. Secondary prevention early identification treatment 3. Tertiary prevention rehabilitation

5. Individual Referred Problem Remedial Restore Group/population Unreferred ‘At Risk’ Protective Enhance Treatment .v. Prevention

6. Best environment meets needs of most distressed infant Worst environment cannot meet needs of healthy, easy going infant Prevention in Child Psychiatry‘good enough parenting’

7. Prevention in Child PsychiatryPublic Policy • 1. poverty alleviation • 2. neighbourhood unity • 3. good housing • 4. employment • 5. child protection from abuse • 6. accident prevention • 7. quality of education • 8. marital and family support

8. Prevention in child psychiatrylife cycle stages • 1. parenthood preparation • 2. antenatal care • 3. birth and neonatal period • 4. preschool period • 5. middle childhood • 6. adolescence

9. Prevention in Child PsychiatryChild Health Services2nd and 3rd prevention • Physical and mental health needs of a child are inseparable 2. Child must be seen in context of their family 3. Parents need to be involved in decision making 4. No one person or profession has all the knowledge or skills 5. Voluntary support groups are helpful

10. Prevention in Child PsychiatryChild Health Services2nd and 3rd prevention 6. Seeing of a child and family not always needed. Consultation to other professionals can be useful • A. psychosocial ward rounds in paediatrics • B. consultations to community care social workers • C. consultations to teachers in school • D. consultations to residential homes • E. consultations to any professional who has child involvement (gp, phn, s/l therapist….)

11. Treatment in Child Psychiatry • Assessment (history and mental state) • Diagnosis (using multi-axial thinking) • Treatment

12. Treatment Modalities • 1. behaviour therapy • 2. individual psychotherapy • 3. family therapy • 4. group therapy • 5. medication therapy • Can be use alone or in combination • Outpatient or inpatient

13. Medication Therapy • Stimulants • Serotonin Reuptake Inhibitors • Neuroleptics - Major Tranquillisers • Minor Tranquillisers • Mood Stabilisers • Hypnotics

14. Behaviour Therapy • Definition of Behaviour ; • ‘all activity of the organism beyond simple physiological functions necessary to sustain life’

15. Behaviour Therapy • Yule 1980 • Guiding principle is that behaviour can be modified by its consequences

16. Behaviour Therapy • Yule 1980 • Reinforcer • Any event which follows on from a behaviour which increases the strength or probability of the behaviour

17. Behaviour Therapy • Yule 1980 • Reinforcer of Childhood? • Attention • Good or Bad

18. Behaviour Therapy the past determines the future

19. Behaviour Therapy • What a parent does AFTER a child has behaved in a certain way is the most important influence the parent has on how that child will behave in the future