Biomedical subjects
Publications and source records attributed to E Malá.
The authors deal with the problem of true and false accusations of sexual abuse by children. They try to describe the characteristics of the family system from which the child comes and draw attention to circumstances which may make the truthfulness of the child doubtful. They remind of criteria needed of professional caution as regards conclusions on the truthfulness of statements in cases of sexual child abuse.
The author defines the terms aggression and aggressiveness. She discusses the relationships between aggressiveness and neurotransmitters, organic change, aggression and punishment. Aggression as a feature of developmental change, aggression and social ethology, development of violence. She describes the problem of self-damage and self-injuring behaviour. The author analyzes comprehensive therapy of aggressive behaviour-preventive, family, behavioural and psychopharmacological treatment (neuroleptics, incl. atypical ones-doses used in children and adolescents, antidepressants, incl. AD of the third generation, anxiolytics, incl. atypical ones, antiepileptics and lithium). Psychopharmaceutical preparations in self-injuring behaviour are reviewed and problems of external stimulation are analyzed.
Evaluation, assessment and statement whether sexual abuse is involved is based largely on the statement of the victim--the child or adolescent. The author describes the differences of games of abused and not abused children. From available sequences recommended and generally accepted during investigations where there is suspicion of sexual abuse she describes in detail the technique of using anatomical dolls.
The etiological aspects of enuresis are diverse. Biological factors such as infection, developmental delay and genitourinary tract malformation must be excluded before the child psychiatrist ever undertakes to treat enuresis. In enuresis patients treated by a psychiatrist, an important role is played by the patients' social setting. These children came more often than controls from broken families, unhappy and quarreling parents who tends to give less attention to their children and encourage early separation. Enuresis is also more frequently associated with psychosocial changes (e.g., hospitalization, birth of a sibling, moving to a new home, etc.). The paper examines developmental stages of the child from the point of view of toilet training, circadian rhythms, and sleep stages from the point of view of enuresis incidence. What has a child psychiatrist to offer? Treatment of enuresis should involve a detailed analysis of the lifestyle, psychotherapy and drug therapy, rehabilitation and re-educational training. The most effective drugs are reviewed; these include tricyclic antidepressives (with a number of side effects) and Adiuretin as the drug of first choice, therapeutically hard-to-control enuresis, enuresis in adolescence, and the Peter Pan syndrome.
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The specificities of the adolescent period are completion of somatic, sexual, emotional, cognitive, intellectual and social maturation. After having coped with this "existential crisis", the adolescents is able to accept new roles, a new identity. Offer described and characterized in detail three types of normal development of adolescents: continual development, accelerated development and precocious development. From the aspect of child and adolescent psychiatry all three described types of development are found in mentally healthy subjects who take life as an open chance.
The author defines the character and symptoms of behavioural disorders in childhood and adolescence. The material is classified according to the concept of continuity and discontinuity of psychiatric symptoms or syndromes and diagnostic entities from childhood to adult age.
A psychiatric disorder well known for more than fifty years in children and adolescents has changed several times its name. Mild child encephalopathy, minimal (mild) cerebral dysfunction, impaired attention, hyperkinetic disorder. The cause is not known, there is, however, evidence of familial disposition. Symptoms of this disorder were fully manifested in patients with generalized resistance to thyroid hormone. The disease is due to a genetic mutation of the beta-thyroid receptor and characterized by a reduced response of the pituitary and peripheral tissue to thyroid hormone. The authors refer to the work of authors, who discovered the association between the hyperkinetic disorder and generalized resistance to thyroid hormone.
A total of 120 children and adolescents with the diagnosis of schizophrenia were hospitalized at the psychiatric clinic in Prague in 1946-1975. Of the 120 patients (58% males and 42% females) 12.5%, i.e. 15 died by 1988. The results are consistent with data in the literature which pertain to pregnancy, family background, relations with people already before the disease developed, social maladaptation, more frequent loss of a parent, depressive symptoms at the onset of the disease, changes on the EEG and neurological examination. The results differ as regards--1. A much greater hereditary load in grade II relatives 45% (19% psychoses, 14% suicides, 12% alcoholism). 2. A greater hereditary load in grade I relatives-parents and siblings (16% psychoses and suicides, 5% alcoholism, 12% personality disorders). 3. The authors detected more psychoses among grade I relatives 14% (11% schizophrenia, 3% manic-depressive psychosis). The hereditary load in the narrower sense of the word in grade I relatives is significantly elevated 16% (14.5% psychoses, 1.5% suicides). Based on the results pertaining to the 15-42-year catamnestic investigation of education, occupation, attempts to work, a certain socialization, attacks and remissions, the authors elaborated the prognosis. The author's prognosis of early onset schizophrenia: 10% complete cure, 17% remission alternating with relapses, 73% chronic patients (20% are capable of a certain socialization; in 53% permanent care by another person is necessary-this applies to chronic patients with a defect-deterioratio and postpsychotic psychopathization.
The authors describe Rett's syndrome, its diagnostic criteria--indispensible, supplementary and eliminating symptoms. Historical development and description and prevalence on a world-wide scale. Detailed account of symptoms of different stages, differential diagnosis (in particular of Rett's and Kanner's syndrome). Course of disease and final stage. The aetiology is obscure, the majority of research workers are inclined to accept the assumption of genetic conditioning of Rett's syndrome.
In the introduction the authors mention the best known authors who investigated the dynamics of interpersonal relations in families with a schizophrenic patient. The illustrative statement of an intelligent loving sister is adopted from article by Brodoff and according to the authors it has transcultural validity. In our country the solution is only modified by socioeconomic dependence of the adolescent and young adult on the nuclear family. Therefore the separation of the healthy sibling takes frequently an inopportune course and should be adjusted by psychological psychiatric intervention within primary prevention. In the conclusion the authors inform on the psychosomatic reaction of mothers after the establishment of the diagnosis of schizophrenia. A total of seven mothers, sick adolescent (four times a son, three times a daughter). In all instances severe prolonged metrorrhagia was involved. According to catamnestic data four times hysterectomy was performed (always without a pathological finding).
Aggressive behaviour of adolescents may be based either on an inborn personality structure, or cultivated by training, i.e. the character of punishment. It is encountered in children with organic disorders of the CNS or psychotic disease. A specific case is aggressive behaviour in communities, being found in particular in communities of boys. The authors describe a typical case of an aggressor and the typical profile of the victim. Psychiatric intervention involves psychotherapeutic treatment and influencing of the social and family which should be focused on possible aggressive behaviour.
The author describes the part played by developmental psychopathology in the epidemiology of psychiatric disorders. Analysis of three basic perspectives. The problem of age and developmental trends due to the incidence of certain psychiatric diagnoses at a certain age (in a certain developmental period). Continuity and discontinuity of normal and pathological forms of behaviour from childhood to adult age. Time patterns of continuity in diagnostic categories of depression, behavioural disorders and schizophrenia. Perspective of causal mechanisms, where two pathways seemed feasible: research of factors reducing the deviant behaviour and investigation of harmonious marriages.
In child psychiatry the developmental aspect is emphasized. Recognition of normal sequence of development in so-called "normal children" makes it possible to reveal pathological conditions (either retardation or acceleration of development, distortion or atypical development). Change-motion-development are philosophical categories considered a manifestation or life--of psychobiological maturation and growth. When investigating the moral development three theories were applied: the developmental theory (Piaget)--learning (Kohlberg), the dynamic theory (Sandler). Among factors which influence in a certain way the moral behaviour the following were selected: age, sex, temperament, family environment. The author describes three stages of moral development in children: preventional stage (moral heteronomy) up to the age of 8 years, conventional and pst conventional (moral autonomy) in adolescence.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.