Chronic Mental Illness and the Changing Scope of Intervention Strategies, Diagnosis, and Treatment in Child and Adolescent Population

Introduction

Although it is sometimes assumed that childhood and adolescence are times of carefree bliss, as many as 20% of children and adolescents have one or more diagnosable mental disorders. Most of these disorders may be viewed as exaggerations or distortions of normal behaviour and emotions. Like adults, children and adolescents vary in temperament. Some are shy and reticent; others are socially exuberant. Some are methodical and cautious; others are impulsive and careless. Whether a child is behaving like a typical child or has a disorder is determined by the presence of impairment and the degree of distress related to the symptoms. For example, a 12-yr-old girl may be frightened by the prospect of delivering a book report in front of her class. This fear would be viewed as social anxiety disorder only if her fears were severe enough to cause significant distress and avoidance. There is much overlap between the symptoms of many disorders and the challenging behaviours and emotions of normal children. Thus, many strategies useful for managing behavioural problems in children can also be used in children who have mental disorders. Furthermore, appropriate management of childhood behavioural problems may decrease the risk of temperamentally vulnerable children developing a full-blown disorder. Also, effective treatment of some disorders (eg, anxiety) during childhood may decrease the risk of mood disorders later in life. The most common mental disorders of childhood and adolescence fall into the following categories:

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  Anxiety disorders,

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  Mood disorders,

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  Disruptive behavioural disorders (e.g., attention-deficit/hyperactivity disorder [ADHD]).

Schizophrenia and related disorders are much less common.

However, more often than not, children and adolescents have symptoms and problems that cut across diagnostic boundaries. For example, > 25% of children with ADHD also has an anxiety disorder, and 25% meet the criteria for a mood disorder.

In this chapter were covered two important chronic mental illnesses in children- Schizophrenia and Bipolar Mood Disorder. This chapter discusses the clinical features, course, outcome and treatment strategies. Special issues in children are also discussed in terms of diagnosis and treatment.