Paediatric Psychiatry | Anatomy2Medicine
Paediatric Psychiatry

Paediatric Psychiatry

    • The age range for administering Wechsler Intelligence Scale for children (WISC-III) is 6-17 years        
      • The WISC-V takes 48–65 minutes to administer and generates a Full Scale IQ (formerly known as an intelligence quotient or IQ score) which represents a child’s general intellectual ability.
      • It also provides five primary index scores (i.e., Verbal Comprehension Index, Visual Spatial Index, Fluid Reasoning Index, Working Memory Index, and Processing Speed Index) that represent a child’s abilities in more discrete cognitive domains.
      • The degree of intellectual impairment is classed on the basis of Wechsler I.Q scale, as follows:
        • Mild, i.e. I.Q. 69-55. These children are educable
        • Moderate, i.e. I.Q. 54-40. These children are trainable
        • Severe, i.e. I.Q. 39-25
        • Pofound, i.e. I.Q. Below 25.
    • A child is said to be mentally retarded if his I.Q is below 70
        • Symptoms of Attention deficit / Hyperactivity disorders,
          • Always “on the go”
          • Easily distracted by extraneous stimuli
          • Often has difficulty organizing tasks and activities
          • Children with the disorder (ADHD) often blurts out answers before questions have been completed.
      • Classical clinical vignette on Attention Deficit / Hyperactivity Disorder in AIPGMEE PG Medical entrance exam
        • Ramu was brought to “Child Guidance Clinic” by his mother with the complaints that he is unable to si in his class. He is in third standard and his teacher frequently complains that he frequently picks fight with his classmates.
        • He is very irritable and easily gets set-off to laughter or tears.
        • Although he is very intelligent in comparison to other children of 7 years of age but is inattentive. Many a times, school peon has observed him trying to start motor bikes in the stand
      • Conduct disorders in a child,
        • Has frequent temper tantrums
        • Often argues with adults
        • Frequently initiates physical fights with peers
      • Hyperkinetic disorder in a child

 

  • Poor impulse control
  • Increased anger outbursts
  • Decreased attention span
  • LowI.Q
  • Amphetamine is the drug of choice

 

      • Lawrence-Moon-Biedel Syndrome Clinical Vignette
        • Bhargav, 6-year-old boy with I.Q of 40, obesity, hypogonadism, polydactyly and retinitis pigmentosa
        • Lawrence-Moon-Biedel Syndrome is characterized by girdle type obesity, sexual underdevelopment, mental retardation, retinal degeneration, polydactyly, and deformity of the skull.
        • The condition is inherited as an autosomal recessive trait.
      • Apert Syndrome. A congenital condition marked by a peaked head and webbed fingers & toes.

 

  • Kleine-Levin Syndrome.

 

      • Charecterised Hypersomnia ,Hyperphagia ,Hypersexuality

 

        • A relatively rare condition,consisting of recurring attacks of prologned sleep with intervening periods of normal sleep and alert waking
        • Wakeful periods during hypersomniac periods may consist of social withdrawal and return to bed at the first opportunity.
        • Apathy, irritability, confusion, and features of psychosis may be present.

 

  • Pica.

 

        • A perversion of appetite with ingestion of material not fit for food, as starch, clay, ashes or plaster.

 

  • Condition seen in pregnancy, chlorosis, hysteria, helminthesiasis, and in certain psychosis.

 

      • Commonest form of Pica is Geophagia

 

    • Autism.
      • The condition of being dominated by subjective, self centred trends of thought or behaviour which are not subject to correction by external information.

 

  • Infantile Autism.

 

      • A severe disorder of communication and behaviour, usually beginning at birth, invariably present at age 3

 

  • It is characterised by self absorption, profound withdrawal from contact with people-including the mother figure, a desire for sameness, pre-occupation with inanimate objects, and developmental language disorders.

 

    • Infantile Autism is characterized by
      • Withdrawal from contact with people
      • Preoccupation with inanimate objects
      • Developmental language disorder present

 

  • Investigations that should be done in a case of primary enuresis
  • Detailed psychiatric assessment
  • Urine examination
  • Intellectual assessment

 

  • The treatment of choice for Nocturnal Enuresis is Imipramine
  • Passive aggression : Clinical Vignette
      • Rajashekar, 12-year-old was playing football when his mother asked him to bring milk from nearby dairy.
      • Rajashekar was reluctant to do the job in the middle of game, but was forced to do so. On his way back, he spilled half of the milk. This is an example of passive agression

 

  • Narcolepsy ; Clinical Vignette

 

    • Vikram a 5th standard student was brought by his parents that his teacher is complaining about his recurrent attacks of irrepressible sleep in the class. Neither the history nor the EEG is suggestive of epilepsy.