Prevention and Treatment in

Child Psychiatry

Dr Finbarr O’Leary

Consultant Child and Adolescent Psychiatrist

Multi – Axial Classification

• 1. psychiatric syndrome

• 2. specific developmental delays

• 3. intelligence

• 4. medical conditions

• 5. psychosocial situations

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

prevention

1. Primary prevention health promotion disease prevention

2. Secondary prevention early identification treatment

3. Tertiary prevention rehabilitation

Treatment .v. Prevention

• Individual

• Referred

• Problem

• Remedial

• Restore

• Group/population

• Unreferred

• ‘At Risk’

• Protective

• Enhance

Prevention in Child Psychiatry

‘good enough parenting’

Best environment meets needs of most distressed infant

Worst environment cannot meet needs of healthy, easy going infant

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

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

Prevention in Child PsychiatryChild Health Services2nd and 3rd prevention

1. Physical and mental health needs of a child are inseparable2. Child must be seen in context of their

family3. Parents need to be involved in decision

making4. No one person or profession has all the

knowledge or skills5. Voluntary support groups are helpful

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….)

Treatment in Child Psychiatry

• Assessment (history and mental state)

• Diagnosis (using multi-axial thinking)

• Treatment

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

Medication Therapy

• Stimulants

• Serotonin Reuptake Inhibitors

• Neuroleptics - Major Tranquillisers

• Minor Tranquillisers

• Mood Stabilisers

• Hypnotics

Behaviour Therapy

• Definition of Behaviour ;

• ‘all activity of the organism beyond simple physiological functions necessary to sustain life’

Behaviour Therapy

• Yule 1980

• Guiding principle is that behaviour can be modified by its consequences

Behaviour Therapy

• Yule 1980

• Reinforcer

• Any event which follows on from a behaviour which increases the strength or

probability of the behaviour

Behaviour Therapy

• Yule 1980

• Reinforcer of Childhood?

• Attention

• Good or Bad

Behaviour Therapy

the past

determines the

future

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