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Here is an essay on ‘Psychiatric Disorders’ that are commonly seen in children. Find paragraphs, long and short essays on ‘Psychiatric Disorders’ especially written for school and college students.
Essay on Psychiatric Disorders
Essay Contents:
- Essay on Developmental Disorders
- Essay on Pervasive Developmental Disorders
- Essay on Specific Developmental Disorders
- Essay on the Disorders of Movement
- Essay on Problems of Toilet Training
- Essay on Elective Mutism
- Essay on Sleep Disorder
- Essay on Eating Disorders
- Essay on Battered Child Syndrome
- Essay on Sibling Jealousy
Essay # 1. Developmental Disorders:
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A. Mental Retardation:
Mental retardation is defined as:
(i) Significantly sub average general intellectual functioning (i.e. 2 standard deviation below the mean). I.Q. below 79.
(ii) Significant deficit or impairment in adaptive functioning.
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(iii) Which manifests during the period of development (i.e. before 18 years of age).
Epidemiology:
There are about 15 million mentally retarded in India (2-3% children of general population). It is twice as common in boys than girls. There are four types of mental retardation depending on I.Q. (±5 points in all types) and adaptive behaviour.
(i) Mild Mental Retardation. (I.Q. 50 to 70):
This constitutes about 85% of total mentally retarded. They can achieve academic level upto 6-8th standard and usually belong to low socioeconomic class. They are educable and trainable.
(ii) Moderate Mental Retardation. (I.Q. 35 to 49):
People in this group account for about 12% of the mentally retarded. Most of them can talk or at least learn to communicate, and most can learn to care for themselves albeit with some supervision. They are trainable (in self-care) but uneducable.
(iii) Severe Mental Retardation (I.Q. 20 to 34):
People with severe mental retardation account for about 7% of the mentally retarded. Many of them can be trained to look after themselves under close supervision and to communicate in a simple way.
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(iv) Profound Mental Retardation (I.Q. below 20):
Less than 1% of mentally retarded, only few of them learn to care for themselves completely.
Disorders frequent among Mentally Retarded:
(a) Physical Disorders:
(i) Sensory Disorders (about 20%):
Defects in vision or hearing
(ii) Motor Disorders:
a) Spasticity
b) Ataxia
c) Athetosis
d) Epilepsy (common among severely retarded)
(b) Psychiatric Disorders (all varieties):
(i) Schizophrenia:
Characterized by poverty of thinking, less elaborate delusions, simple and repetitive hallucinations; also called “Pfropf schizoiphrenie”.
(ii) Affective Disorder.
(iii) Neurosis common in less severely retarded.
(iv) Personality Disorder
(v) Organic Psychiatric Disorders:
Dementia is usually diagnosed after age 18 years or when there is definite decline in intellectual capacity and adaptive behaviour. There is particular association between Alzheimer’s disease and Down’s syndrome
(vi) Autism and Over Activity Syndromes:
(vii) Behaviour Disorders:
Mannerisms, head banging and rocking; hyperkinetic syndrome; Others e.g., temper tantrums, self-stimulation, pica, undue dependency, legal problems (rarely).
(viii) Sexual Problems:
Masturbation in public is the most frequent sexual problem.
Effects of Mental Retardation on the Family:
Parents show:
a) Distress, Feelings of rejection
b) Depression, guilt, shame or anger
c) Overindulgence
d) Social problems
e) Marital disharmony (in some)
f) Dissatisfaction about medical and social services (even when they are normal)
Important Causes of Mental Retardation:
(a) Down’s Syndrome:
Epidemiology:
It is the commonest chromosomal disorder, occurring in one in every 600-700 births. The retardation is usually mild or moderate.
Etiology:
a) Trisomy 21 (commonest, the karyotype of mother is normal).
b) Translocation between Chromosome 21 and 15.
c) Mosaicism occurs when non-dysfunction (with both normal and trisomic cells present).
The risk in a woman 25 years old is 1 in 2300, 1 in 100 for women between 40 and 45 years, 1 in 46 for older than 45.
Classical Features:
a) Small mouth and teeth, furrowed tongue, high arched palate.
b) Oblique palpebral fissures, epicanthic folds
c) Flat occiput
d) Short and broad, curved fifth fingers, single transverse crease
e) Hyperextensibility or hyperflexibility, hypotonia, poor Moro reflex
f) Congenital heart disease (especially arterioventricular communis, ventricular septal defect, patent ductus arteriosus). Brushfield spots, flat facies, small dysplastic ear, impaired hearing and intestinal abnormalities, I.Q. generally between 20 and 50. Hypothyroidism, epilepsy, ocular disturbances, reduced fertility etc. are also seen.
Treatment:
There is no definitive treatment. The major cause of early mortality is congenital heart disease.
(b) Fragile X-Chromosome:
Occurs in approximately 1 in 1,000 to 1 in 2000 male births. It is the second most common chromosomal abnormality linked to mental retardation, after Down’s syndrome.
The diagnosis is established by demonstrating the constriction at the long arm of the X-chromosome, which frequently appears as if it were broken.
One third are retarded (usually mildly), one third have a learning disability and one-third are normal.
Clinical Features:
Long ear, a long, narrow face, short stature and pectus excavatum (about 25%), abnormalities suggesting connective tissue disorder such as mitral valve prolapse (upto 55%), enlarged aortic root and high arched palate. Some of these characteristics are also found in affected females, severe to mild retardation with learning disabilities. There may be hypotonia, attention deficit hyperactivity disorder, self-stimulation, hand flapping, gaze aversion, etc.
Treatment:
Treatment with high dose of folic acid had been proposed for people with fragile-x chromosome.
(c) Klinefelter syndrome:
It refers to a form of hypogonadism comprising of small testes with hyalinized seminiferous tubules, failure of development of secondary sexual characters and increased gonadotrophins.
It may be chromatin positive or negative. The frequency is about 1.32 per 1000 among newborns, about 7 to 9/1000 among mentally retarded.
The patients are tall, underweight, have occasionally hypospadias or cryptorchidism and also psychosocial, learning or school adjustment problems. Puberty is delayed, growth of public and facial hair is often late, while the public hair is generally feminine in distribution. Gynecomastia, appearing usually soon after puberty between the ages of 14 and 16 years. Testes are small.
Treatment:
Replacement therapy with long acting testosterone preparations. Dose of 50 mg every 3 weeks, with increase of 50 mg every 6 to 9 months. Maintenance dose for adults is 250 to 300 mg every 3 weeks.
(d) Turner’s Syndrome:
45 XO or 45 XX chromosomal pattern with an incidence of about 1:3000 newborns.
The diagnosis is evident at birth from oedema of the dorsum of the hands and feet, loose skinfolds in the nape of neck and often short stature. Manifestations in childhood comprise short stature, webbing of the neck, appearance of short neck with low posterior hairlines, anomalous ears, prominent narrow and high arched palate, small mandible and epicanthic folds, broad chest with widely placed nipples (hypoplastic), cubitus valgus, (high carrying angle), medial tibial exostosis, short fourth metocarpals and metatarsals, pigmented nevi, failure of sexual maturation and associated defects in kidney (horse shoe kidney, double or cleft renal pelvis), heart (coarctation of aorta in 70%) and perceptive hearing defect.
Treatment:
Replacement therapy with oestrogens to initiate sexual maturation is deferred till the age of 15 to 16 years to avoid early closure of epiphyses.
(e) Phenylketonuria:
It is a metabolic disorder with autosomal recessive inheritance. The levels of hepatic enzyme phenylalanine hydroxylase is low, therefore L-phenylalanine cannot be converted to tryrosine. Phenylalanine accumulates in blood, CSF and tissues.
Clinical Characteristics:
The various signs and symptoms include retarded development resulting in gross intellectual impairment, tremors, convulsions, hyperkinesis, muscular hypertonia, blond hair, blue iris and fair skin, inflammatory lesions, rashes, eczema and musty body odour.
Diagnosis:
Guthrie’s test.
Treatment:
Phenylalanine is restricted in the diet of infants.
Differential Diagnosis of Mental Retardation:
a) Delayed maturation (Specific Developmental Disorders).
b) Blindness or other sensory defects.
c) Childhood psychosis (Childhood onset Schizophrenia).
d) Childhood autism.
e) Severe neuroses.
f) Systemic disorders with physical handicap.
g) Deprived children with insufficient stimulation.
h) Epilepsy.
i) States due to the side effects of drugs (e.g., antipsychotics, anticonvulsants etc.).
Management:
(i) Primary Prevention:
(a) Health Promotion:
Good antenatal care, improving the socioeconomic status of the country, education of the public, facilitating research to identify the causes.
(b) Specific Protection:
Good prenatal, natal and postnatal care, genetic counselling to at risk patients e.g., in phenylketonuria, avoiding childbirths in late age of the mother, avoiding consanguinal marriages, avoiding marriages of mentally retarded, vaccination of girls with rubella vaccine, avoid giving pertussis vaccine to children with history of convulsions.
(ii) Secondary Prevention (Early diagnosis and treatment):
a) Early detection and treatment of the preventable disorder
b) Amniocentesis and medical termination of pregnancy on medical grounds.
c) Early detection of correctable disorders.
d) Early detection of physical handicaps.
e) Prevent them against abuse e.g., physical or sexual abuse.
(iii) Tertiary Prevention:
(a) Disability Limitations:
Treatment of physical and psychological problems (by drugs, behaviour modification); institutionalization of severe mentally retarded or those with psychological problems; education (if educable) and training to avoid handicaps; physiotherapy to treat the associated deficits.
(b) Rehabilitation:
This is the cornerstone of management of the mentally retarded children. It depends on the patient’s level of intelligence and his aptitude.
Hospitalization Indications:
(a) Behavioural Difficulties:
Behavioural difficulties due to attention deficit disorder with hyperkinesis; destructive, assaultive behaviour; psychoses; organic psychoses.
(b) Social Factors:
Overcrowding; incompetent parents; mentally retarded or psychotic parent; single parenthood; no one to look after.
Essay # 2. Pervasive Developmental Disorders:
(a) Autistic Disorder:
The condition was described by Leo Kanner (1943) as ‘infantile autism’.
Epidemiology:
By definition the onset is in infancy or childhood. The prevalence of the disorder is 4 to 5 per 10,000 in children under 16 years of age.
The male-to-female ratio is 4 to 5 to 1.
Etiology:
(i) Genetic Factors:
The higher concordance in monozygotic than dizygotic twins (36% versus 0%)
(ii) Medical Causes:
Postnatal neurological infections (meningitis, encephalitis), congenital rubella and cytomegalovirus, phenylketonuria and rarely perinatal asphyxia. Seizure disorder appears in 35 to 50% by age 20. Neurological abnormalities are present in about one-quarter of class. (“Soft signs”).
(iii) Psychodynamic and Parental Influences:
The parents of autistic children as intellectual, obsessive socially reserved, cold and emotionally detached (so called “refrigerator parents”).
(iv) Biochemical:
About one-third of autistic children have elevated serotonin levels, the significance of which is unclear.
Clinical Picture:
The characteristic features are:
(i) Autism:
Autism (Inability to make warm emotional relationships with people).
(ii) Communication:
There is marked qualitative impairment in verbal (language) or nonverbal communication and in imaginative activity.
(iii) Activities:
Marked restricted repertoire of activities and interests.
a) Stereotyped body movements.
b) Persistent preoccupation with parts of objects (e.g., spinning wheels).
c) Marked distress over changes in trivial aspects of environment.
d) Unreasonable insistence on following routines in precise details.
e) Markedly restricted range of interests.
(iv) Other Features:
a) Mental Retardation:
Mental retardation (more than half of autistic children have moderate to profound retardation whereas about 25% have mild mental retardation).
b) Idiot Savant Syndrome:
Inspite of a pervasive or abnormal development of functions, certain functions may remain normal e.g., calculating ability, prodigious remote memory, musical abilities etc.).
c) Kanner’s “Autistic triad”:
Kanner said their autistic aloofness, speech and language disorder and obsessive desire for sameness constitute a triad characteristic of infantile autism.
Prognosis:
About 10 to 20 percent autistic children begin to improve between 4 to 6 years of age.
I. 10 to 20% can live at home but need to attend a special school or training center and cannot work.
II. 60% improve little and unable to lead an independent life.
Differential Diagnosis:
(i) Childhood Schizophrenia (See Table 27.2)
(ii) Reactive attachment disorder of infancy (RADI)
(iii) Elective Mutism
(iv) Others:
Tourette’s disorder, habit disorder, obsessive compulsive disorder, attention deficit disorder, specific developmental (language) disorder, acquired aphasia with convulsions, schizoid personality, hearing or neurodegenerative diseases and mental retardation.
Treatment:
(i) Behaviour Modification:
Positive reinforcement to teach self-care skills; speech therapy; structured class room training; development of regular routine with minimum or no changes; behavioural techniques to encourage social and interpersonal interactions.
(ii) Counselling and Supportive Therapy
(iii) Medication:
a. Antipsychotics:
Haloperidol—helpful in decreasing hyperactivity and other disruptive (temper tantrums etc.) behaviour.
b. Dopamine Agonists:
CNS Stimulants (amphetamines or methylphenidate) improve hyperactivity Levodopa is useful in autistic cases.
c. Fenfluramine:
It may cause reduced motor symptoms, enhanced social relatedness, improved attention and sleep patterns and increased I.Q.
e. Naloxone and Naltrexone:
Naloxone and Naltrexone are pure opiate receptor antagonists. They decrease self- injurious behaviour, aggressiveness, hyperactivity, impulsivity, withdrawal and stereotypies.
f. Others:
Others e.g., Antiepileptic drugs, atypical antipsychotics (e.g., risperidone, olanzapine etc.)
(b) Rett’s Syndrome:
A condition, so far reported only in girls, for which the cause is not known:
I. Typically apparently normal or near- normal early development is followed by partial or complete loss of acquired hand skills and of speech together with deceleration in head growth, usually with an onset between seven and 24 months of age.
II. Loss of purposive hand movements, hand wringing stereotypies and hyperventilation.
III. Arrest of social and play development in the first two or three years but social interest tends to be maintained.
IV. Truncal ataxia and apraxia with scoliosis or kyphoscoliosis, in middle childhood.
V. Sometimes choreoathetoid movements
VI. Severe mental handicap and fits (during early or middle childhood generally before the age of eight years)
VII. Deliberate self-injury and complex stereotyped preoccupation are rate.
(c) Childhood Disintegrative Disorder (Heller’s syndrome):
A type of pervasive developmental disorder (other than Rett’s syndrome) that is defined by the presence of a period of definitely normal development prior to the onset of the disorder and by a definite phase of loss of previously acquired skills over the course of a few months, that extends across at least several areas of development; together with the onset of characteristic abnormalities of social, communicative and behavioural functioning. In some cases loss of skill is persistently progressive but a limited improvement may be seen. The prognosis is usually very poor with most individuals left with severe mental retardation.
It resembles dementing conditions of adult life but it differs in 3 key respects: a lack of evidence of any identifiable organic disease or damage; loss of skills followed by a degree of recovery; and impairment in socialization and communication rather than intellectual decline.
The other terms used are Heller’s syndrome, Disintegrative psychosis, symbiotic psychosis, dementia infantilis. It needs differentiation from pervasive developmental disorder, schizophrenia, Rett’s syndrome, elective mutism and epilepsy with acquired aphasia.
(d) Asperger’s Syndrome:
A disorder of uncertain classification, characterized by the same type of qualitative impairment of reciprocal social interaction that typifies autism together with a restricted stereotyped repetitive repertoire of interests and activities. It differs from autism primarily in the fact that there is no general delay or retardation in language or in cognitive development.
Most individuals are of normal general intelligence but are clumsy.The occurs primarily in boys (boys: girls = 8:1). The abnormalities tend to persist into adolescence and adult life and the characteristics are not affected by environmental influences. Psychotic episodes occasionally occur in early adult life.
The other names are—autistic psychopathy and schizoid disorder of childhood.
Essay # 3. Specific Developmental Disorders:
They are:
(a) Developmental Arithmetic Disorder:
Difficulty with arithmetic is probably the second most common specific learning disorder that cannot be explained in terms of generally low I.Q.
Etiology:
Arithmetical ability correlates with l.Q. and classroom training.
Treatment involves special education.
(b) Developmental Expressive Writing Disorder:
Difficulties in spelling, grammar, sentence and paragraph formation and punctuation are characteristic.
Symptoms include slow writing speed and low volume output, illegibility, letter reversals, word finding and syntax errors, erasures, rewritings, spacing errors and punctuation and spelling problems.
Genuine remedial therapy is possible with educational interventions typically consisting of alternative writing formats and skills building.
(c) Developmental Reading Disorder:
Common ‘dyslexia’ is characterized by a slow acquisition of reading skills. Slow reading speed, impaired comprehension, word omissions and distortions and letter reversals are outside to the expected performance levels based on age and I.Q. This disorder is seen in the presence of normal intelligence, appropriate education, motivation and emotional control.
Etiology:
May result due to disturbance in mental retardation, brain damage, psychiatric disturbances (especially influences on attention and anxiety), sensory deficits, cultural deprivation and inadequate schooling.
Characteristics:
There is also left-right disorientation, impairment in sound discrimination, perceptual-motor skills (i.e., letter reversals (b, d), word transposition (saw, was), omissions (truck, tuck), and substitution (truck, trick), spelling problems (severe and long lasting), verbal language deficits, seizures or symptoms of left hemisphere injury, attentional difficulties, conduct disorder etc.
Epidemiology:
Prevalence about 3 to 10% in general population with male female ratio 3-4:1 %.
Assessment and Treatment:
Treatment is given by remedial teachers:
(d) Developmental Coordination Disorder:
(Specific motor retardation): Some children have delayed motor development, which results in clumsiness in school-work or play apraxia. About 5% of children have significant impairments of gross or fine motor functions. Special training can be tried though without great hope of success.
(e) Developmental Speech and Language Disorders:
About 1% of children are seriously retarded in speech and 5% have difficulty in making themselves understood by strangers. There may be developmental articulation disorder, expressive or receptive language disorder. Speech therapy is the usual treatment and is beneficial in many patients.
Essay # 4. Disorders of Movement:
See Table 27.3
(a) Attention Deficit Hyperkinetic Disorder:
See Table 27.3.
Tourette’s disorder has multiple vocal and motor ties of more than 1 year duration and is usually seen before 11 years of age and almost always before 21 years of age.
Essay # 5. Problems of Toilet Training:
(a) Non-Organic Enuresis (Bed-Wetting):
Enuresis refers to the wetting of one’s clothes or one’s bed, past the age of three years. If the child has never attained bladder control, it is called Primary enuresis an if the child has once attained the bladder control for about one year and then gets this disease, it is known as Secondary Enuresis. Bed-wetting is repetitive, inappropriate, involuntary passage of urine.
It is estimated that 15 percent of children wet past the age of three while in adults, the prevalence varies from 0.5 to 3.8 percent.
80% of enuretic wet only during night while 15% during day and night and rest during day only.
More common in males and in winter, enuresis is often familial and seen more in children coming from joint families.
Etiology:
I. Genetic:
Enuresis is more common in children who have family history of this problem in parents or siblings.
II. Psychological:
Separation from parents; disturbed family (martial disharmony etc.); birth of a sibling; anger, punishment or rejection from caretakers.
III. Physiological:
Delayed or lax toilet training.
IV. Organic:
Diabetes mellitus; worms infestation; urinary obstruction and infection (common in females); epilepsy and sleep disorders; deformities like spina bifida, weak bladder musculature, urethral value etc.
Treatment:
(i) Parental Counselling
(ii) Behaviour Modification Methods:
Mowrer and Mowrer devised an apparatus (available in India also) consisting of an alarm buzzer which could set off by the discharge of urine onto a detector circuit and child wakes up from sleep to pass urine at a proper place.
(iii) Drugs:
Drugs like imipramine (25-50mg/d) (avoided before 6 years of age due to cardiac toxicity), oxybutynin (5-20 mg/d) or decompress in inhalation.
(iv) Situational Manipulation:
These include waking the child during course of the night, restricting fluids (water, milk, etc.) at 1-2 hours before sleep and avoiding certain kinds of spices or nutrients (Lemon juice, tea etc).
(b) Non-organic Encopresis (soiling):
It involves repeated, involuntary evacuation of feces into clothing without gross organic cause after the age of four years, with or without constipation. The other terms used to describe this condition are “soiling”, ‘bowel accidents’, ‘incontinentia alvi’, ‘psychogenic megacolon’ etc.
Epidemiology:
The prevalence of encopresis among children is 4 to 8 percent. It is three to four times more common among boys than girls.
Types:
Encopresis can be continuous type (never trained), discontinuous type (once toilet trained but soils later in response to stress), and retentive soilers (also called secondary retentive type).
Etiology:
(i) Genetic or Constitutional:
High rate of language disorder and characteristic findings of maturational lag in children who have family history of encopresis.
(ii) Organic Causes:
Fever, dyspepsia, anal fissure, diarrhoea, abuse of laxatives, calcium and potassium deficiency, after operation, spinal cord injury, colonic atony, worms manifestation, tuberculosis, spasticity of anal sphincter, chronic constipation etc.
(iii) Emotional Factors:
Unpleasant or coercive toilet training, an unsatisfactory relationship to the familial environment, separation from the mother, birth of a sibling, start of school, poor peer relationship.
Treatment:
(i) General Measures:
Toilet training should be started at an appropriate age (between two and three years of age) and coercive toilet training should be avoided.
The use of enemas, large doses of laxatives for obstination are undesirable.
(ii) Specific Measures:
Any contributory organic factor should be ruled out.
The psychotherapy (with child and parents) and eventual interpretation of conflicts relieves the psychological stress.
Behaviour modification through the introduction, rearrangement or withdrawal of reinforcement contingencies is very effective.
Essay # 6. Elective Mutism:
Mutism is the absence of articulate speech but when mentally and physically sound persons forced themselves into mutism, it is called elective mutism (a term coined by Tramer in 1934).
Types:
(a) Primary:
Children who manifest primary elective mutism characteristically refuse to speak and to strangers.
(b) Secondary:
This may occur in cases of hearing loss, schizophrenia, hysterical aphonia, aphasia, mental retardation etc.
Prevalence:
It is more prevalent in girls and there are families in which more than one child is mute. Elective mutism is more common in the early preschool years.
Etiology:
i. Environmental factors (strange environment or strangers).
ii. Separation of child from the family (especially at the time of his entry into school).
iii. Heredity and intelligence may play some part, though the disorder is basically psychogenic.
iv. Excessive ties to the mother
v. A traumatic experience at the time the child is developing speech
vi. As a far-reducing device or as an attention getting mechanism.
vii. As a problem solving device, against the expression of anger or the use of symptom to punish a parent or peer.
Management:
The different children with the same syndrome are silent for different reasons and need individually developed therapeutic programs.
Essay # 7. Sleep Disorder:
a. Nightmares.
b. Night terrors.
c. Somnambulism.
d. Excessive/inadequate sleep.
e. Bruxism.
Essay # 8. Eating Disorders:
a. Anorexia nervosa
b. Bulimia nervosa
c. Obesity
d. Pica
e. Rumination disorder
f. Failure to thrive.
g. Compulsive Water Drinking
Essay # 9. Battered Child Syndrome:
In abuse, the child suffers from the physical assault from an adult. It differs from corporeal punishment in that the child is too immature for conscious knowledge of misdeed. The repeated physical abuse of children was called by Kempe as Battered child syndrome.
Prevalence:
The National Center of Child Abuse and Neglect estimates from Washington that a million children are being maltreated by their parents each year, as many as 2 lacs sexually abused and 2 to 3 lacs psychologically abused.
Causes:
(i) Children:
Many abused children are perceived by their parents as being different, slow in development or mentally retarded, bad, selfish or hard to discipline.
(ii) Parents:
The perpetrator is more often the woman who is the victim of emotionally cripped or foster parents, had immature, narcssistic, egocentric, demanding, impulsive and aggressive personality.
(iii) Crisis Situations:
Divorce, alcoholism, drug addiction, teenage pregnancies, mental retardation, recurring mental illness, unemployment, financial distress and social isolation.
Diagnosis:
While the more severely abused children are seen in the emergency wards with bruises, abrasions, cuts, lacerations, burns, multiple fractures, ocular, chest, or abdominal injuries.
On examination, the child shows signs of neglect, disproportionate or repeated soft tissue injuries or fractures.
Treatment:
The treatment of neglected and abused children is given by a team consisting of pediatrician, psychiatrist, nurse, social worker and hospital administrator.
Essay # 10. Sibling Jealousy:
Jealousy is an unpleasant feeling induced by any interference or attempt to thwart the efforts to gain a love object, either a person, power, possession or position.
Epidemiology:
Jealousy between the ages of one and five is a normal reaction common to most children. Sibling rivalry is seen in as much as 20 to 40 percent of children below 2 years of age and in only 3 percent of adolescents over 16 years old.
Clinical Features:
Selfishness and pugnacity are the prominent traits. Destructiveness and restlessness are also not uncommon whereas truancy, lying and stealing occurred infrequently. There are also high prevalence of sleep disturbances, food capriciousness, temper tantrums, anxiety, depression, behaviour problems and enuresis among these children.
Etiology:
i. Lack of constructive training.
ii. A history of domestic friction (because of marital discord and divided discipline).
iii. Children as objects of teasing.
iv. Arrival of new baby in the family leading to parental neglect.
v. Inferiority feelings, rudeness and destructiveness in both genders.
Treatment:
Sibling rivalry is a normal emotional response in children below 5 years of age but when jealousy has become pronounced, therapy has two major tasks:
(i) Help the parents to review and, if possible, revise their attitudes toward their children.
(ii) The child is given an opportunity to express and enact his feelings.
Prevention of Childhood Psychiatric Disorders:
It is obviously better to prevent child psychiatric disorders than to treat them once they are established but in the past, less attention has been given to prevention than to treatment services. Prevention is important because treatment methods are not easily available and by no means uniformly effective.
There are three levels of prevention:
(1) Primary Prevention:
It consists of planned programmes designed to reduce the incidence of specific pathological conditions, whether psychiatric illness or mental handicap in a population of children not currently suffering from such conditions. Primary prevention involves the identification of risk factors and then, removing them in time. The risk factors, which are known to be significant, include—genetic factors (provision of genetic counselling services can reduce the incidence of genetic disorders e.g., mental retardation etc. It is often combined with amniocentesis, in genetically ‘at risk’ pregnant mothers).
Pregnancy risk factors include infections of the mother (like rubella, syphilis, toxoplasmosis), smoking, alcoholism, toxemia of pregnancy etc. which affect foetal development should be avoided.
Birth trauma (good obstetric care can reduce the incidence of birth trauma resulting in damage to brain and other parts of the foetus).
Prematurity and Neonatal Medical Disorders:
Accidents in and outside the home (these are common causes of neurological and other injuries, which may lead to psychiatric disorder or mental handicap), Poisons: (lead, arsenic etc.), Physical illnesses (especially of nervous system).
Cultural deprivation (there is higher prevalence of psychiatric disorders, mental handicap, learning failure at school in culturally deprived homes), family disharmony and disruption (children from such families generally have higher rates of emotional and behavioural disorders), parental mental illness (It is a particularly serious risk factor when both parents suffer mental illness and also when the disorder is severe and prolonged), early school failure (often associated with specific learning disorders, hyperkinesis and neurological problems), larger family size (associated with an increased incidence of juvenile delinquency), foster children.
In contrast to risk factors, there are, however, many protective factors which make the development of a disorder less likely. These are female sex, adaptable temperament, isolated stress, good coping skills, a good relationship with ‘atleast’ one parent and improved family circumstances.
Epidemiological data, combined with evidence concerning risk factors, intervening variables and protective factors, enable rational plans to be made for programmes of primary prevention.
2. Secondary Prevention:
It involves, early diagnosis and case finding, followed by intervention to bring the disorder under control as rapidly as possible. In most school systems, children are tested and assessed regularly to detect early evidence of both emotional disorders and learning disabilities. What is secondary prevention for one child may become primary prevention for other children belonging to same troubled families. In Britain and USA the principal service is provided by health visitors or trained nurses while in India, the main emphasis lies on making the parents and teachers aware about the detection of childhood disorders.
3. Tertiary prevention:
It aims to limit the effect of the disorder, to prevent its getting worse and to give support to the affected individual or family. Generally, however, primary and secondary prevention are preferable and more economic uses of scarce professional time.
Prevention of childhood psychiatric disorders is important to decrease the increasing prevalence of crime, delinquency, family break up, divorce rate, drug abuse and suicide.