Early Detection of Mental Disorders in Children Module Course Code: XGA10045

Coordinator: Department of Psychiatry FMUI/RSCM Foreword Children's mental health problems is a problem that needs to be a concern at this time because of changes in various aspects of life, such as advances in information technology and globalization so that the flow of information flows rapidly without a filter. In addition, the presence of various crises in Indonesia increased cases of domestic violence accompanied by increase in violent behavior towards children. School as a place of education for children, so far only focused in improving the child's academic skills, while life skills has not yet be focused enough, thus making a child's social skills not developed to the optimum. All this certainly made an impact in the occurrence of psychiatric disorders in children in Indonesia. Data of the National Mental Health Policy from 2001 to 2005 showed that the ratio of mental/emotional health disorders in the group of children aged 4-15 years is 104/1000 children. In a study of the prevalence of emotional and behavioral problems in children of primary school age in Central Jakarta in 2003 using Child Behavior Checklist instrument (Rahadian and Wiguna, 2003), 27% of children had emotional and behavioral problems. Prevalence in boys was more than girls (30.5% vs. 22.6%). Problems of internalization (anxiety, depression, and self-isolation) were greater when compared with problems of externalization (30% vs. 10.2%). Ang and Wiguna (2007) studied the prevalence of mental disorders in children in junior high school in Central Jakarta by using MINI for Kids instrument and found a prevalence of 26.5%. Mental disorders are more common in female students compared to male students. The type of mental disorder most commonly found are mood disorders, anxiety disorders, impaired concentration and attention/hyperactivity (GPPH), and behavioral disorders. In this elective module the mental disorders in children are focused on the 3 (three) types of mental disorders most often encountered in the clinic, which are pervasive developmental disorders, concentration problems and hyperactivity, and mental retardation. Number of Students: Minimum 2 people/Maximum 5 people. Introduction Early Detection of Mental Disorders in Children elective module is part of the educational program for students of FMUI in the Division of Child and Adolescent Psychiatry, Department of Psychiatry FMUI/RSCM that will run in the second semester academic year 2009-2010. Praise to the Almighty God, the instructional design book of this module can be compiled thanks to the help from the staff of at the Division of Child and Adolescent Psychiatry. This module, along with the pre-clinical and other clinical modules, is hoped to provide enough knowledge and skills for the students to further understand some of the many mental disorders in children commonly encountered in the community. In the long run, it is hoped that the knowledge gained in this module can help students to be physicians who can address health problems in the clinic and in the community. The module team would like thank for the input and constructive criticism for the improvement in the preparation and execution of the module. Background

Children's mental health problems is a problem that needs to be a concern at this time because of changes in various aspects of life, such as advances in information technology and globalization so that the flow of information flows rapidly without a filter. In addition, the presence of various crises in Indonesia increased cases of domestic violence accompanied by increase in violent behavior towards children. School as a place of education for children, so far only focused in improving the child's academic skills, while life skills has not yet be focused enough, thus making a child's social skills not developed to the optimum. All this certainly made an impact in the occurrence of psychiatric disorders in children in Indonesia. Data of the National Mental Health Policy from 2001 to 2005 showed that the ratio of mental/emotional health disorders in the group of children aged 4-15 years is 104/1000 children. In a study of the prevalence of emotional and behavioral problems in children of primary school age in Central Jakarta in 2003 using Child Behavior Checklist instrument (Rahadian and Wiguna, 2003), 27% of children had emotional and behavioral problems. Prevalence in boys was more than girls (30.5% vs. 22.6%). Problems of internalization (anxiety, depression, and self-isolation) were greater when compared with problems of externalization (30% vs. 10.2%). Ang and Wiguna (2007) studied the prevalence of mental disorders in children in junior high school in Central Jakarta by using MINI for Kids instrument and found a prevalence of 26.5%. Mental disorders are more common in female students compared to male students. The type of mental disorder most commonly found are mood disorders, anxiety disorders, impaired concentration and attention/hyperactivity (GPPH), and behavioral disorders. In this elective module the mental disorders in children are focused on the 3 (three) types of mental disorders most often encountered in the clinic, which are pervasive developmental disorders, concentration problems and hyperactivity, and mental retardation. Module objectives Through this module and other modules that the students underwent, it is hoped that the seven competencies to be achieved at the first degree, which was listed in CBC 2005 FMUI, related to the neuropsychiatry field is owned by a doctor after undergoing their education. These seven competencies are: 1. Effective Communication 2. Basic clinical skills 3. Basic science to practice medicine 4. Management of medical and health problems 5. Information technology 6. Self awareness and lifelong learning 7. Ethics, morals, and professionalism in practice Specific objectives After completing this elective module, students should be able to: 1. Communicate effectively both verbally and nonverbally in a dignified manner in an attempt to manage the client and pediatric patients by integrating clinical and biomedical reasoning that support the creation of good cooperation between doctor and patient, family, community, peers, and other professionals involved in the handling of mental disorders in children. 2. Conduct psychiatric interviews and complete physical examination with the correct techniques and record a complete history of the disease. 3. Explain all routine clinical procedures and analyze secondary data of patients with mental disorders by integrating biomedical science and clinical science. 4. Choose a variety of clinical, laboratory and other supporting procedures and interpret the results. 5. Determine diagnosis from secondary data and plan management and referral of children with mental disorders, which include pharmacological and non-pharmacological

management on individuals, families, and communities to implement evidence-based medicine approach. 6. Seek, collect, collate, and interpret information regarding the problem of mental disorders in children from various sources by utilizing information and communication technology to assist the diagnosis, therapy, prevention and health promotion, as well as monitoring the health status of patients. 7. Recognize ethical issues and dilemmas and medico-legal problems in clinical situations associated with mental disorders in children and know when and how to get expert assistance or other sources in resolving those ethical and medico-legal choices 8. Be sensitive to the patients values and integrate moral considerations and the clinical knowledge/skills in resolving ethical issues related to mental disorders in children. Related disciplines: Biochemistry, Physiology, Nutrition, Clinical Pathology, Pharmacology, Radiology, Pediatric Neurology, Pediatric Psychiatry, and Medical Rehabilitation Students Characteristics Students who can attend the early detection of mental disorders in children elective module are students who have passed the first phase of medical education, so they have achieved a variety of skills learned in accordance with the objectives of Phase I - General Education that were trained in Basic Education for Higher Education Module (PDPT). These students have achieved the basic skills and attitudes, namely lifelong learning skills, a variety of generic skills and a caring attitude towards the environment/society. Learning Objectives Terminal Learning Objectives When encountered with pediatric patients with psychiatric disorders (pervasive developmental disorders, concentration problems and hyperactivity, and mental retardation), accompanied by secondary data from the laboratory, radiology and epidemiology of the mental disorders, students undergoing elective module are capable of interpreting these data and applying them in solving problems in a standard problem solving steps including preventive measures and referral, with the use of appropriate medical and information technology, by always paying attention to the concept and development of ethics. Supporting learning objectives After attending this module, second phase students are expected to achieve the following capabilities: 1. When given patient data that includes: The results of anamnesis (the patient's complaint, the patient's life history, history of past illnesses, patients socio-cultural environment) The results of a complete general physical examination, neurologic, and psychiatric Supporting tests (laboratory, radiology, etc.) students are able to: Formulate the patients problem Describe the structure and physiology of the organs associated with the pathophysiological, psychopathological, and pathogenesis of the problem Explain the scientific basis of the disorders Explain the basis of diagnosis and differential diagnosis Determine the laboratory/other investigations needed based on pathophysiology, psychopathology, and pathogenesis of the problem and able to interpret the results of these data

Plan the management of therapy (pharmacology and non-pharmacology) Explain the basic pharmacological and non-pharmacological treatment of the problems Explain the prognosis, sequelae, the impact of management, the impact of patients illness towards the family, as well as the financing system and where to find referral services when needed. 2. When encountered with a child who has a certain mental disorders, students are able to: Conduct psychiatric interview to both the child and the parents in accordance with the ethical-humanistic problem approach (in BCS module) Perform a routine physical examination in a lege artis method in accordance with the problem (in BCS module) Perform neurologic and psychiatric examination to obtain a complete neurologic and mental status of the child Determine the necessary supporting tests Interpret the results of the supporting tests and relate them with the patient's clinical condition Perform multi-axial diagnosis for psychiatric diagnosis in children, as well as the differential diagnosis Plan the management (pharmacology and non-pharmacology) Explain the prognosis, sequelae, the impact of management, the impact of patients illness towards the family, as well as the financing system and where to find referral services when needed.

SCOPE
Scope
The concept of psychiatry and mental health in children and adolescents

Topics
The basic concept in the field of child psychiatry Psychiatry and child psychiatry's role in medicine The basic concept of child mental health Psychobiology aspect on mental disorders Sociocultural aspects of mental disorders Doctor-patient relationship Psychiatric interview on children Overview and clinical symptoms

Subtopics
Biopsychosocial concept Eclectic holistic concept The role and authority of physicians in child mental health services Child mental health in the community Role of child mental health in the functioning of community health centers and public hospitals Neurobiology and neurochemical aspects Sociocultural aspects Parents' parenting method The interaction between nurture and nature The doctor patient relationship Active listening Empathy Non-verbal communication Communication with the parents and children with mental retardation, PDD, and GPPH Open, control and close an interview Mental status examination in children with (identification of various types of specific

Common causes of mental disorders in children and adolescents

Psychiatric examination and clinical features in children with: 1. Mental retardation 2. Pervasive developmental disorders 3. Concentration problems and hyperactivity

Psychopharmacotherapy in the field of child and adolescent psychiatry

Biological Therapy

Psychosocial therapy in the field of child and adolescent psychiatry

Psychotherapy Mental rehabilitation

psychopathology) 1.Mental retardation 2.Pervasive developmental disorders 3.Concentration problems and hyperactivity Description and clinical symptoms of: 4.Pervasive developmental disorders 5.Concentration problems and hyperactivity 6.Mental retardation Multi-axial evaluation (axis I to V) Pharmacodynamics of drugs often used in children with psychiatric disorders Pharmacokinetics of drugs often used in children with psychiatric disorders Dosage, side effects and interactions of drugs frequently used in the field of child and adolescent psychiatry Play therapy Cognitive-behavioral therapy Other various psychosocial treatment approaches

REFERENCES
BIOCHEMISTRY Compulsory textbook: 1. Lodish H et al. Nerve cells. In: Molecular cell biology. 3rd ed. New York; Scientific American, WH Freeman: 1996. pp. 925-90. 2. Karp G. Membrane potensials and nerve impulses. In: Cell and molecular biology. 2nd ed. New York; John Wiley: 1999. pp. 166-79. 3. Mark DB et al. Neurotransmitter synthesis. In: Basic Medical Biochemistry. 1st ed. Baltimore; William Wilkins: 1966. pp. 659-65 CLINICAL PATHOLOGY Compulsory textbook: 1.Kjeldsberg CR, Knight JA. CerebroSpinal fluid. In : Body fluids. 2nd ed. ASCP Press: 1986. pp.31-67. 2. Strasinger SK. CerebroSpinal fluid. In : Urinalysis and body fluids. 3rded . Philadelphia ; FA Davis:1994. pp.135-52. 3. Gandasoebrata R. Penuntun laboratorium klinik. Jakarta; Dian Rakyat: 1989. pp. 158-70.

PHARMACOLOGY 1. Seksi III: Obat Susunan Saraf Pusat. In: Buku Ajar Farmakologi dan Terapi. edisi V Jakarta; Dept. Farmakologi dan Terapi FKUI: 2007. pp. 139 209. 2. Potter WZ, Hollister LE. Antidepressant agents. In: Katzung BG ed. Basic & Clinical Pharmacology. 9th ed. Singapore; Mc.Graw Hill: pp. 482-95. 3. Potter WZ, Hollister LE. Antipsychotic agents and Lithium. In: Katzung BG ed. Basic & Clinical Pharmacology. 9th ed. Singapore; Mc.Graw Hill: pp. 463-81. 4. Aminoff MJ. Pharmacologic management of Parkinsonisme and other movement disorder. In: Katzung BG (ed). Basic & Clinical Pharmacology. 10th ed. Singapore: McGraw Hill: pp. 442-56. RADIOLOGY 1. FKUI. Buku Radiologi. Jakarta; FKUI: ( buku hitam). 2. David Sutton. Textbook of radiology and imaging. 7th ed. Churchill Livingstone: 2003. 3. David Stark, William G Bradley. Magnetic Resonance Imaging. 3 ed. Mosby: 1999. PSYCHIATRY Compulsory textbook: Micheal Rutter, Eric Taylor. Child and adolescent psychiatry. 4th edition. USA. Blackwell Science Ltd. 2006. Kaplan HI, Sadock BJ. Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry. 10 th edition. Philadelphia; Lippincott Williams & Wilkins: 2008 Patel V. Where There is No Psychiatrist-A Mental Health Care Manual. The Royal Colleage of Psychiatrist: 2003. World Health Organization. Diagnostic and Management Guidelines for Mental Disorders in Primary Health Care - ICD X. Hogrefe & Huber: 1996. Recommended textbook: Kaplan HI. Emergency of Psychiatry. Philadelphia; Lippincott Williams & Wilkins: 2003. Direktorat Kesehatan Jiwa, Depkes RI. PPDGJ III dan Suplemen PPDGJ III. Jakarta; Depkes RI: 1995. Metoda Pembelajaran
1. Lectures (10 hours) Aims to provide insight into the extensiveness and scope of the problems in the field of child psychiatry, providing an understanding of the concepts, terms and mechanisms, especially the difficult ones and to generate interest and enthusiasm of students to want to delve deeper into, and conduct research in the field of neuropsychiatry. a. The concept of general psychiatry and child mental health (1 hour) b. Common causes of mental disorders of children (1 hour) c. Psychiatric and clinical examination in children with mental retardation (2 hours) d. Psychiatric and clinical examination in children with PDD (2 hours) e. Psychiatric and clinical examination in children with GPPH (2 hours) f. Psychopharmacology in the field of child and adolescent psychiatry (1 hour) g. Psychosocial therapy in the field of child and adolescent psychiatry (1 hour) Practicals @ 2 hours (6 hours) 1. Psychiatric examination in children 2. Children with pervasive developmental disorders Clinical activities (48 hours) 1. Clinical activity in child and adolescent psychiatry clinic FMUI/RSCM a. Case presentation 1 b. Case presentation 2 Code

K-1 K-2 K-3 K-4 K-5 K-6

2. 3.

Code P-1 P-2 Code KK-1 KK-1a KK-1b

4.

Clinical activity in pediatric growth and development clinic FMUI/RSCM a. Case presentation 1 b. Case presentation 2 Problem based learning (36 hours) Problem based learning consists of group discussions, self-directed learning and plenary A B C Group discussion (GD) with 2 triggers @ 6 hours (12 hours) 1. Trigger 1 2. Trigger 2 Self-directed learning (18 hours) Plenary and summary (of GD) @ 3 hours (6 hours)

2.

KK-2 KK-2a KK-2b Facilitators

DK-1 DK-2 Moderator Resource persons

LEARNING RESOURCES Sources of learning include: Textbooks Hand-outs (resource persons) Practical Guidelines Internet INSTRUCTIONAL MEDIA Instructional media used: LCD Computer, VCD Player White Board Flip Chart Demonstration video CD, lab materials CD, and other lab materials

Matrix of Activities
Week I Time 07.00-08.00 Monday Introduction of Early Detection of Mental Disorders in Children Elective Module General concept of psychiatry and mental health in children and adolescents Common causes of mental disorders in children Psychiatric and clinical examination in children with mental retardation Tuesday Psychiatric and clinical examination in children with concentration problems and hyperactivity Wednesday Thursday Friday

Group Discussion Trigger 1

Group Discussion Trigger 1 Plenary 1 + feedback

08.00-09.00

09.00-10.00

Practical 1 10.00-11.00

Practical 2

Clinical work 1

Psychosocial therapy in the field of child and adolescent psychiatry Clinical work 1

11.00-12.00 12.00-13.00 13.00-13.00

Psychopharmacotherapy in the field of child psychiatry

Clinical work 2

Clinical work 1

14.00-15.00

Psychiatric and clinical examination in children with pervasive developmental disorders

Formative evaluation 1 Group Discussion Trigger 1 Clinical work 2 Clinical work 1 Self-directed learning

15.00-16.00 Week II Time 07.00-08.00 08.00-09.00 09.00-10.00 10.00-11.00 11.00-12.00 12.00-13.00 13.00-13.30 13.30-14.00 14.00-15.00 15.00-15.30 15.30-16.00

Self-directed learning

Monday Group Discussion Trigger 2 Clinical work 2

Tuesday Group Discussion Trigger 2 Clinical work 1

Wednesday Group Discussion Trigger 2 Clinical work 2

Thursday Plenary 2 + feedback Clinical work 1

Friday Self-directed learning Clinical work 1

Clinical work 2

Case presentation 1

Clinical work 2

Clinical work 1

Formative Evaluation 2 Self-directed learning

Self-directed learning

Week III Time 07.00-08.00 08.00-09.00 09.00-10.00 10.00-11.00 11.00-12.00 12.00-13.00 13.00-14.00 14.00-15.00 15.00-16.00

Monday Self-directed learning Clinical work 2

Tuesday Self-directed learning Clinical work 1

Wednesday Self-directed learning

Thursday Self-directed learning Clinical work 1

Friday Summative Evaluation

Clinical work 2

Clinical work 2

Case presentation 2

Clinical work 2 Self-directed learning

Clinical work 1

List of Teaching Staff

List of Resource Persons

No 1 2 3 Lecture The general concept of psychiatry and child and adolescent mental health Common causes of mental disorders in children Psychiatric examination and clinical features in children with mental retardation Psychiatric examination and clinical features in children with PDD Psychiatric examination and clinical features in children with GPPH Psychopharmacotherapy in the field of child and adolescent psychiatry Psychosocial therapy in the field of child and adolescent psychiatry Code K-1 K-2 K-3 Day Date Time Lecturer Dr. Lukas Mangindaan, SpKJ Dr. Jan Prasetyo, SpKJ (K) Dr. Noorhana SWR, SpKJ (K) Dr. Ika Widyawati, SpKJ (K) Dr. Tjhin Wiguna, SpKJ (K) Dr. Irawati Masubrin, SpKJ (K) Dr. Gitayanti H, SpKJ (K)

4 5 6 7

K-4 K-5 K-6 K-7

Location: Meeting room at the Department of Psychiatry FMUI/RSCM

Plenary Resource Persons
Plenary I Topic Concentration and hyperactivity disorders + mental retardation Pervasive developmental disorders Day Date Time Dept Moderator/Resource Persons Dr. Irawati M (moderator) Dr. Tjhin Wiguna (resource person) Dr. Ika Widyawati (resource person) Dr. Tjhin Wiguna (moderator) Dr. Noorhana SWR (resource person) Dr. Gitayanti H (resource person)

II

List of practical coordinator and tutor Lab coordinator: Practical Coordinator P-1 Dr. Tjhin Wiguna P-2 Dr. Ika Widyawati

Module Team
Advisor Chair Vice chair Members : Dr. Ika Widyawati, SpKJ (K) : Dr. dr. Tjhin Wiguna, SpKJ (K) : Dr. Gitayanti Hadisukanto, SpKJ(K)

:Dr.dr. Irawati Ismail M., SpKJ (K) Dr. Noorhana SWR, SpKJ (K) Dr. Lukas Mangindaan, SpKJ (K) Secretariat (1 person) : Elin FACILITIES Lecture hall: Lecture hall at the Department of Psychiatry FMUI/RSCM Child and Adolescent Psychiatry Clinic FMUI/RSCM Pediatric Growth and Development Clinic FMUI/RSCM Evaluation 1. Evaluation of Learning Outcomes (Individual) Formative: During interactive lectures and practicals (formative quizzes, lab reports) Summative: MCQ 1 Method Written test MCQ 1 Practical Exam Observation/evaluation by the facilitator of group discussion Students notebook lab report/summative quiz Weighting (%) 30 20 20 10 10