Child psychiatry is much more different than adult - Prof. Khalida Tareen


Child psychiatry is much more different
than adult - Prof. Khalida Tareen

Children are disturbed and do not want to talk, hence one must first develop
some relationship with them before making diagnosis and initiating treatment

LAHORE: Prof. Khalida Tareen Prof. Emeritus of Child Psychiatry at King Edward Medical University along with Dr. Nazish Imran and Dr. Wajid chaired the special session devoted to Child Psychiatry during the recently concluded Asia Pacific Conference on Psychosocial Rehabilitation on second day of the conference. Dr. Anjum Bashir Consultant Child and Neuropsychiatrist from UK was the first speaker who made a presentation on emotional disorders in children reported in detail in our last issue of November 15th 2013. Dr. Anjum Bashir referring to a study conducted in Pakistan said that 70% of women in rural areas were hit by their husband and they do it to control their wives. Those who can hit their wife can also hit the children, he remarked.
During the discussion it was stated that child abuse was not a new phenomenon in Pakistan. It was there since long. It was further pointed out that those who are abused today could turn out to be the abusers of tomorrow.

Prof. Khaida Tareen along with Dr.Nazish Imran and Dr. Wajid chairing a session
during the Asia Pacific Conference on Psychosocial Rehabilitation held at Lahore recently.

Dr. Faria Khan was the next speaker who talked about Autism and Psychosis in adolescents. Its prevalence was reported to be 0.4%. Differential diagnosis includes early onset schizophrenia, affective psychosis and reactive psychosis. These children have impaired ability to make friendship, they have restricted pattern of interest, narrow interests, and any change is quite upsetting for them. They remain in social isolation, have limited relationship, and have awkward interaction with peers. There are potential areas of confusion both positive and negative. She also discussed their symptoms in detail. Out objective should be to improve service provision for people presenting with autism and psychosis, she stated.
Dr. Shermin Imran from UK talked about assessment and management of adolescent psychosis. She referred to the diagnostic uncertainty in adolescent psychosis as well as challenges in its treatment. Recurrence rate, she opined, is quite high. She then talked about precipitatory and maintaining factors, risks to self and others property, choice of anti psychotics, compliance, duration of treatment, off label use of drugs for treating this disorder. She suggested that one should always start with a small dose of drug and then gradually increase the dose. In treatment resistance cases, use of clozapine is very good in seriously ill patients but its use in children is still controversial. Resperidone and olanzapine are preferred in UK. Weight gain with the use of olanzapine in children is a problem and one can move to clozapine, if need be, she added. Speaking on clinical psychosis, Dr. Faria Khan said that conduct disorders are seen more in case of parental discord and gender has no effect.
In her concluding remarks Prof.Khalida Tareen said that child psychiatry is much more different than adult psychiatry. Children suffer from stronger anxiety, they are disturbed and do not want to talk. The treating psychiatrist has to come to their level right from the beginning. It is important to spend some time with these children before thinking of making diagnosis and initiating any treatment. Adolescents are difficult to handle for parents and doctors; hence one has to develop a relationship with them. Parental discord, she said, was a generalized thing. Discussions’ among the parents is a good thing, disagreement is also good at times but discord among parents should not affect the children, she remarked.

Industry sponsored Symposia

Dr. Wajid Ali Akhundzada along with Dr. Sadaf Rashid chaired the session sponsored by Abbott Pakistan on the role of Fluvoxamine in obsessive compulsive disorders. Dr. Nasar Sayeed Khan from SIMS Lahore was the speaker. In his presentation Dr. Nasar Sayeed Khan pointed out that anxiety is often associated with depression. It could be agitation, psychic anxiety, and somatic anxiety. The prevalence of depression with anxiety is about 14-18% in general population. Only 50% of patients consult the healthcare professionals and less than 50% are correctly diagnosed. Most of these patients do not receive adequate treatment and many do not get therapeutic dosage. Suicidal ideation is a challenge to treatment. Some patients are resistant to treatment. He also referred to the impact of depression with symptoms of anxiety. The drugs used must be effective antidepressants and it must reduce the symptoms of anxiety with depression. SSRIs treat these symptoms better. He then also briefly talked about the mechanism of action of Fluvoxamine. His conclusions were that symptoms of anxiety are common in depression. Depressed patients have worse prognosis and drug therapy should consist of effective and safe antidepressants.

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