绪论分类保健

1、CHILD AND ADOLESCENTS P S Y C H I A T R Y and MENTAL HEALTHOutlinePreface of Child and Adolescents PsychiatryClassification of Child Classification of Child Mental Disorders Child Mental Health ServicesdefinitionChild and Adolescents Psychiatry is the academic and clinical discipline which studying

2、caring for children and adolescents with Emotional disordersbehavioral disordersdevelopmental disorders definitionChild and Adolescents Psychiatry PathogenyMechanismPhenomenaTreatmentPreventionindividualdefinitionChild and Adolescents Mental Health :Environment Life eventparent-child relationsPal-re

3、lationsSelf-behaviorsNeed of mass and prevention The field of child and adolescent psychiatry is quite young.1867 Maudsley H. first described insanity of early life in his book Physiolgy and pathology of mind1950 formal training programs in child psychiatry become popular in American1970 quick devel

4、opment The social sciences (social and communal factors, family functioning, parent-child relations) Many basic science contribute to knowledge relavant it The biological science (brain development)The child developmental psychology EducationEpidemiologyChild and adolescent mental health is an essen

5、tial part of overall health. World-wide up to 20% of children and adolescents suffer from a disabling mental illness (WHR, 2000). World-wide suicide is the 3rd leading cause of death among adolescents (WHR 2000). Major depressive disorder (MDD) often has an onset in adolescence, across diverse count

6、ries, and is associated with substantial psychosocial impairment and risk of suicide (Weissman, 1999) Epidemiology Xin RE(1992) CBCL 12.97%Li XR (1993) DSM-III-R 14.89%It mean that there are 46770000 children need help in China.Poor outcomesLight and Bailey (1998) report that longitudinal studies fi

7、nd that about half the children with psychiatric disorders exhibit the same or similar disorders years later. Conduct disorder related behaviours tend to persistent into adolescence and adult life through drug abuse, juvenile delinquency, adult crime, antisocial behaviour, marital problems, poor emp

8、loyee relations, unemployment, interpersonal problems, and poor physical health (Patterson, DeBaryshe, & Ramsey, 1989). Current states of child mental health Most Scandinavia countries, many European countries and American : about one child psychiatrist for every 50,000 people in the populationI

9、n China :less than 100 child psychiatrist throughout the country0 0101020203030404050506060707080809090 Current states of child mental health1950s-1970s, a few doctors working in the child psychiatric clinic in big cities. The first Child psychiatry clinic in China was established in Nanjing by Dr.

10、Tao Guotai. Chinese Child Mental Health Board of Chinese Mental Health Association was established in 1989Now, many child psychiatry research institutes have been built, including clinics, wards and caring centers for children and adolescents in Beijing, Nanjing, Shanghai, Changsha, Chengdu, Fuzhou,

11、 Jinan, and so on. Child mental health clinics have also been built in more cities. Social need increasingEmotional quotient (EQ, Garduer H and Salovey P.) The ability to accurate appraisal and expression of emotions in oneself and others to regulate emotion in a way that enhances living to recogniz

12、e the consensually agreed upon emotional qualities of objects in the environment. The achievement of one depend upon IQ 20% EQ 80% Social need increasingo控制情绪、乐观、控制情绪、乐观、o坚韧、不屈、耐受挫折坚韧、不屈、耐受挫折o抵制诱惑、恒心、毅力抵制诱惑、恒心、毅力o良好的人际关系良好的人际关系o创造性、独立性创造性、独立性落实计划生育国策，落实计划生育国策，“优生，优育，优优生，优育，优教教”，加强儿童精神卫生保健工作显得尤，加强儿童精

13、神卫生保健工作显得尤为重要为重要Classification理想的分类是按病因分类。但多数精神疾病病理想的分类是按病因分类。但多数精神疾病病因不明，目前的分类是按性质，兼顾病因、病因不明，目前的分类是按性质，兼顾病因、病理学分类和症状学分类理学分类和症状学分类分类的目的：化繁为简，集合障碍中性质、表分类的目的：化繁为简，集合障碍中性质、表现和结局相似者作为一个诊断类别，有利于治现和结局相似者作为一个诊断类别，有利于治疗和预后。疗和预后。再按其从属关系细分为病种和病型再按其从属关系细分为病种和病型以儿童孤独症为例以儿童孤独症为例 病类：心理发育障碍病类：心理发育障碍 病种：广泛性发育障碍病种：广

14、泛性发育障碍 病型：儿童孤独症病型：儿童孤独症 ClassificationWHO(1992) : International ClassificationClassification of Disease, Ten Edition(ICD-10)APA(1994):Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-IV)Chinese Classification of Mental Disorders-Version 3(CCMD-3) 2000 7.Mental retardation, a

15、nd disorder of psychological developmental with onset usually occurring in childhood and adolescenceChinese Classification of Mental Disorders-Version 3(CCMD-3) 2000 8. Hyperkinetic, Conduct,and Emotional disorders with onset usually occurring in child and adolescenceClassification71.1 Specific spee

16、ch articulation disorder71.2 Expressive language disorder71.3 Receptive language disorder71.4 Acquired aphasia with epilepsy71.9 Other or unspecified developmental disorders of speech and language 70. Mental retardation 71.Developmantal disorder of speech and languageClassification72.1 Specific read

17、ing disorder 72.2 Specific spelling disorder72.3 Specific disorder of arithmetical skills 72 Specific developmental disorders of scholastic skillsClassification72.4 Mixed disorder of scholastic skills 72.9 Other or unspecified developmental disorders of scholastic skills 73 Specific developmental di

18、sorder of motor skills 74 Mixed specified developmental disordersClassification75.1 Childhood autism75.2 Atypical autism75.3 Retts syndrome75.4 Childhood disintegrative disorder75.5 Aspergers syndrome75.9 Other or unspecified Pervasive developmental disorders75 Pervasive developmental disorders Clas

19、sification80. 1 Attention deficit and hyperactivity disorder80.2 Hyperkinetic conduct disorder8 0 . 9 O t h e r o r u n s p e c i f i e d hyperkinetic disorder 80. Hyperkinetic disorderClassification81.1 Dissocial conduct disorder81.2 Oppositional defiant disorder81.9 Other or unspecified conduct di

20、sorder 81 Conduct disorders 82 Mixed disorders of conduct and emotions83.1 Separation anxiety disorder of childhood 83.Emotional disorders with onset specific to childhood 83.2 Phobia anxiety disorder of childhood 83.3 Social anxiety disorder of childhood 83.Emotional disorders with onset specific t

21、o childhood 83.91 General anxiety with onset specific to childhood Classification84.1 Elective mutism84.2 Reactive attachment disorder of childhood84.9 Other or unspecified childhood disorders of social functioning 84.Disorders of social functioning with onset specific to childhood and adolescence C

22、lassification85.1 Transient tic disorder85.2 Chronic motor or vocal tic disorder85.3 Tourettes syndrome85.9 Other or unspecified tic disorder 85.Tic disordersClassification86.1 Nonorganic enuresis86.2 Nonorganic encopresis86.3 Feeding disorder of infancy and childhood86.4 Pica of infancy and childho

23、od86.6 Stuttering86 Other hehavioral disorders with onset usually occurring in childhood and adolescence 89 Other or unspecified childhood disorders of social functioning儿童心理保健定义儿童心理保健定义根据不同年龄儿童的心理特点，运用心理学的一般原理，进行心理健康教育和训练，促进儿童的智力发展和健康人格的形成，塑造良好的心理素质和灵活的社会适应能力，提高儿童的心理健康水平。研究影响儿童心理发展的各种因素，包括危险因素与保护因素

24、。主要是指生活环境、亲子关系、同伴关系以及自身行为等社会心理因素如何影响儿童的心理发展。 早期发现、早期诊断、早期干预各种心理问题，预防后续问题的发生。国际国内对儿童青少年心理卫生提出国际国内对儿童青少年心理卫生提出了更高的要求了更高的要求 世界卫生组织召开了一次“关爱儿童青少年心理卫生-设定WHO方向研讨会”，会议回顾了该领域当前的一些问题，提出了具体的实施方案。指出儿童作为弱势群体，需要更多的关爱；发展中国家要制定相关政策以促进儿童的精神卫生，保证儿童能够得到合理的保健，正确的、质高价廉的服务。 The WHO School Contest, held as part of World H

25、ealth Day 2001 which had the theme “Stop Exclusion: Dare to Care” Chinese President Jiang Ze-min in his letter to Dr Blundtland, the secretary-general of WHO, has emphasized Chinese government will mobilize the whole society to create a suitable environment for people with mental disorders to go bac

26、k society.国务院国务院2001年年5月月22日发布的中国儿童发日发布的中国儿童发展纲要（展纲要（2001-2010）主要目标第）主要目标第5条为：条为：“加强儿童卫生保健教育，提供各种形加强儿童卫生保健教育，提供各种形式的儿童心理健康咨询及不良心理矫正式的儿童心理健康咨询及不良心理矫正服务服务“策略措施第策略措施第5条为条为”重视儿童心理卫生知重视儿童心理卫生知识的普及，在学校开展心理健康课程，识的普及，在学校开展心理健康课程，逐步在大中城市和其他有条件的地方建逐步在大中城市和其他有条件的地方建立儿童心理健康咨询和矫正服务机构立儿童心理健康咨询和矫正服务机构 卫生部、民政部、卫生部、

27、民政部、 公安部、中国残疾人联合公安部、中国残疾人联合会发布的中国精神卫生工作规划（会发布的中国精神卫生工作规划（2002201020022010）要求要求加强儿童、青少年学生心理健康教育和干预，加强儿童、青少年学生心理健康教育和干预，减缓心理行为问题和精神疾病上升趋势。减缓心理行为问题和精神疾病上升趋势。 到到20052005年，在校学生心理保健知识知晓率达到年，在校学生心理保健知识知晓率达到4 04 0 ； 到 ； 到 2 0 1 02 0 1 0 年 ， 达 到年 ， 达 到 6 0 6 0 。 。 到到20052005年，遏止儿童、青少年心理行为问题和年，遏止儿童、青少年心理行为问题和

28、精神疾病总患病率上升趋势；到精神疾病总患病率上升趋势；到20102010年，儿童、年，儿童、青少年心理行为问题和精神疾病总患病率降低青少年心理行为问题和精神疾病总患病率降低到到1212。 今年我国精神卫生日的主题今年我国精神卫生日的主题:“ “ 快乐心情，健康行为快乐心情，健康行为 关注儿童青少年情绪行为关注儿童青少年情绪行为” ” 一级预防模式（社区）一级预防模式（社区） 1、优生：婚前、孕前、产前遗传咨询，加强孕期与围产期保健，减少对胎儿与新生儿脑发育的影响。 2、优育：通过孕妇学校、早教学校、家长学校以及各种形式的科普宣传等形式，提高家长的儿童心理知识，提供正确的养育儿童的方法，促进儿童心理与社会适应能力的发展。 一级预防模式（社区）一级预防模式（社区） 3、优教：对于幼儿园、学校教师要进行心理学知识的培训，开展素质教育，根据儿童的特点采取个性化的、符合心理学原理的教育方法，开发儿童的潜能，塑造儿童良好的个性，形成良好的适应能力。