Hyperkinetic disorders. Hyperkinetic disorders Features of pharmacological therapy

This group of disorders is characterized by an early onset; a combination of overly active, poorly modulated behavior with pronounced inattention and lack of perseverance in completing any tasks. Behavioral features are manifested in any situations and are constant in the time interval.

Etiology / pathogenesis

Hyperkinetic disorders usually occur in the first 5 years of life. Their main features are the lack of perseverance in cognitive activity, the tendency to move from one task to another without completing any of them; excessive but unproductive activity. These features are stored in school age and even in adulthood. Hyperkinetic children are often reckless, impulsive, prone to getting into difficult situations due to rash actions. Relationships with peers and adults are broken, without a sense of distance.
Secondary complications include dissocial behavior and reduced self-esteem. There are often accompanying difficulties in mastering school skills (secondary dyslexia, dyspraxia, dyscalculia and other school problems).

Diagnosis

Most difficult to differentiate from behavioral disorders. However, if most of the criteria for hyperkinetic disorder are present, then the diagnosis should be made. When there are signs of severe general hyperactivity and conduct disorders, the diagnosis is hyperkinetic conduct disorder (F90.1).
The phenomena of hyperactivity and inattention may be symptoms of anxiety or depressive disorders(F40 - F43, F93), mood disorders (F30-F39). The diagnosis of these disorders is based on their diagnostic criteria. Dual diagnosis is possible when there are separate symptoms of hyperkinetic disorder and, for example, mood disorders.
The presence of an acute onset of hyperkinetic disorder at school age may be a manifestation of a reactive (psychogenic or organic) disorder, manic state, schizophrenia, neurological disease.

Symptoms

The main symptoms are attention disorders and hyperactivity, manifested in different situations- at home, in children's and medical institutions. Frequent change and interruption of any activity is characteristic, without attempts to complete it. Such children are overly impatient, restless. They can jump up during any work, talk excessively and make noise, fidget... Comparison of the behavior of such children with other children of this age group is diagnostically significant.
Related clinical characteristics: disinhibition in social interaction, recklessness in dangerous situations, thoughtless violation social rules, interruption of classes, rash and incorrect answers to questions. Learning disorders and motor clumsiness are quite common. They should be coded under (F80-89) and should not be part of the disorder.
Most clearly, the clinic of the disorder manifests itself at school age. In adults, hyperkinetic disorder can manifest itself in dissocial personality disorder, substance abuse or other impaired condition social behavior.

Treatment

Outpatient treatment - with mild manifestations of hyperkinetic disorders. If it is impossible to relieve symptoms on an outpatient basis, with a protracted course and persistent school maladjustment - treatment in a hospital.

Forecast

With most forms emotional disorders the prognosis is favorable.

This group of disorders is characterized by an early onset; a combination of overly active, poorly modulated behavior with pronounced inattention and lack of perseverance in completing any tasks. Behavioral features are manifested in any situations and are constant in the time interval.

Hyperkinetic disorders usually occur in the first 5 years of life. Their main features are the lack of perseverance in cognitive activity, the tendency to move from one task to another without completing any of them; excessive but unproductive activity. These characteristics persist through school age and even into adulthood. Hyperkinetic children are often reckless, impulsive, prone to getting into difficult situations due to rash actions. Relationships with peers and adults are broken, without a sense of distance.

Secondary complications include dissocial behavior and reduced self-esteem. There are often accompanying difficulties in mastering school skills (secondary dyslexia, dyspraxia, dyscalculia and other school problems).

Prevalence

Hyperkinetic disorders are several times more common in boys than girls (3:1). AT primary school the disorder occurs in 4-12% of children.

Symptoms of Hyperkinetic Disorders:

The main signs are attention disorders and hyperactivity, which manifest themselves in various situations - at home, in children's and medical institutions. Frequent change and interruption of any activity is characteristic, without attempts to complete it. Such children are overly impatient, restless. They can jump up during any work, talk excessively and make noise, fidget... Comparison of the behavior of such children with other children of this age group is diagnostically significant.

Associated clinical characteristics: disinhibition in social interaction, recklessness in dangerous situations, thoughtless violation of social rules, interruption of classes, thoughtless and incorrect answers to questions. Learning disorders and motor clumsiness are quite common. They should be coded under (F80-89) and should not be part of the disorder.

Most clearly, the clinic of the disorder manifests itself at school age. In adults, hyperkinetic disorder may manifest as dissocial personality disorder, substance abuse, or another condition with impaired social behavior.

Diagnosis of Hyperkinetic Disorders:

Most difficult to differentiate from behavioral disorders. However, if most of the criteria for hyperkinetic disorder are present, then the diagnosis should be made. When there are signs of severe general hyperactivity and conduct disorders, the diagnosis is hyperkinetic conduct disorder (F90.1).

The phenomena of hyperactivity and inattention may be symptoms of anxiety or depressive disorders (F40 - F43, F93), mood disorders (F30-F39). The diagnosis of these disorders is based on their diagnostic criteria. Dual diagnosis is possible when there are separate symptoms of hyperkinetic disorder and, for example, mood disorders.

The presence of an acute onset of a hyperkinetic disorder at school age may be a manifestation of a reactive (psychogenic or organic) disorder, a manic state, schizophrenia, or a neurological disease.

Hyperkinetic conduct disorder - deviation common in children. Boys of primary school age are most susceptible to the development of the disease.

Pathology in different ages manifests itself in different ways, but, regardless of the severity of symptoms, needs supervision by a specialist. The treatment of pathology is to provide psychological help taking special medications.

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general information

Hyperkinetic behavior disorder is accompanied by severe behavioral abnormalities.

Characteristic signs of pathology can be noted in children of the youngest age.

Among these signs are inattention, excessive hyperactivity, restlessness, . These manifestations are observed in many children, however, this is not a reason to say that there is any pathology, in most cases these are just character traits.

We can talk about the presence of pathology if these symptoms significantly affect the life of the child, his academic performance, relationships with peers.

Kinds

Depending on the age of the child, the pathology manifests itself in different ways. Thus, there are 3 main types of deviations, depending on age:

Symptoms and signs

Pathology can manifest itself in different ways, depending on the nature of the child, social conditions in which he is, as well as age.

However, there are a number common features characteristic of this deviation. There are 3 main types of symptoms.

Some children also have other signs of pathology. In particular, it is possible impaired coordination of movements, fine motor skills hands. The child often reacts inadequately to failures (irritability, aggression, tearfulness).

The bad behavior of the child becomes the cause of hostile relations in the team, which, in turn, further exacerbates emotional condition baby.

Causes

The following can lead to the development of hyperkinetic conduct disorder: negative factors:

1. Developmental disorders or damage to brain tissue, in particular in the right hemisphere of the brain.
2. Severe intoxication of the body caused by negative impact harmful chemicals.
3. Taking certain medications.
4. Developmental disorders (for example, with oxygen starvation, low water).
5. Frequent stress, unfavorable emotional atmosphere in the family, team.
6. Unbalanced diet (in particular, insufficient amount of food consumed, improper introduction of complementary foods).

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Is there a link to attention deficit?

Certainly, there is such a connection. It is no coincidence that throughout years these two concepts considered synonyms. However, certain differences still exist, they are in a set of characteristic features.

So, if the attention deficit manifests itself mainly in learning difficulties (which is also typical for children with hyperactivity), clinical picture hyperkinetic conduct disorder is more extensive.

Which doctors should be contacted?

If the baby has characteristic symptoms You need to consult a psychiatrist.

Diagnostics

Can make an accurate diagnosis only a psychiatrist after studying the characteristics of the behavior and character of the child.

When identifying signs of deviation, it is important to remember that they should not be single, that is, one or another symptom should be periodically repeated over a certain period of time (6-12 months). The following diagnostic methods are used:

1. Conversation with a child(often the baby denies the presence of certain signs of pathology), as well as with his parents, caregivers, teachers (adults, on the contrary, may exaggerate the severity of clinical manifestations).
2. Observation for the behavior of the baby in his natural conditions of stay (at home, in kindergarten, school, others in public places).
3. Creation of artificial life situations,behavior assessment baby in them.

As noted earlier, children with hyperkinetic disorders have certain problems with learning and behavior, not only in public places, but also at home.

This means that in order to achieve positive result it is necessary not only to correct it in the conditions of the school, but also the observance by parents of certain rules regarding the baby at home:

1. It is good if, when doing any homework, the baby will use simple, but sequential instructions and hints parents. This will give him confidence in his abilities, contribute to the development of self-organization.
2. Parents' requests should be presented to the child in a form that is accessible to him, calm voice.
3. At the baby have to do housework. The list of these cases (for 1 day) must be written out on a separate sheet of paper, hang it in a conspicuous place accessible to the child.
4. When a child does any work that requires perseverance and attention (for example, self-study at home), make sure that the baby does not get tired, allow him to do short (no more than 15-20 minutes) breaks.
5. A hyperactive child has an increased supply of energy that needs to be thrown out somewhere. Best suited for this purpose active games outdoors, sports.
6. Follow baby's diet. If you notice that the child becomes overexcited after eating certain foods, these foods should be avoided.

Forecasts

Subject to all necessary conditions (timely treatment prescribed by a doctor, creating favorable emotional conditions, attention from parents and teachers), the prognosis in most cases is favorable.

If alarm signals as symptoms of hyperkinetic disorder leave without attention, there is a risk of more serious mental disorders appearing in adulthood.

This includes antisocial behavior, aggression, alcohol abuse, drug use, and other negative manifestations.

Many young children are prone to excessive mobility, inattention, and emotionality. However, it is not always the case pathological deviation.

We can talk about hyperkinetic disorder when these features give the baby certain problems in learning and relationships. Certainly, this pathology it is necessary to treat, the choice of one or another method of treatment is carried out by a doctor observing a small patient.

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RCHR ( Republican Center Health Development Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2010 (Order No. 239)

Hyperkinetic conduct disorder (F90.1)

general information

Short description

is a group of complex behavioral disorders characterized by the presence of a certain number of signs in three categories: inattention, impulsivity and hyperactivity (attention deficit hyperactivity disorder) with the presence of criteria for a social behavior disorder.

Protocol"Hyperkinetic Conduct Disorder"

ICD 10 code: F 90.1

Classification

Clinical classification according to the severity - mild, pronounced.

Diagnostics

Diagnostic criteria

To be diagnosed with hyperkinetic disorder, the condition must meet the following criteria:

1. Violation of attention. For at least six months, at least six signs of this group must be observed in severity incompatible with the normal stage of development of the child. Children:
- unable to complete a school or other assignment without errors caused by inattention to detail;
- often unable to complete the work or game performed;
- often do not listen to what they are told;
- usually fail to follow the clarifications needed to complete school or other assignments (but not because of oppositional behavior or failure to understand instructions);
- often unable to properly organize their work;
- avoid unloved work that requires perseverance, perseverance;
- often lose items that are important for performing some tasks (stationery, books, toys, tools);
- are usually distracted by external stimuli;
are often forgetful in daily activities.

2. Hyperactivity. For at least six months, at least three of the signs of this group are noted in severity that does not correspond to this stage child development. Children:
- often swing their arms and legs or roll around in their seats;
- leave their place in the classroom or other situations in which perseverance is expected;
- running around or climbing somewhere in inadequate situations for this;
- often noisy in games or incapable of quiet pastime;
- demonstrate a persistent pattern of excessive motor activity, uncontrolled by the social context or prohibitions.

3. Impulsivity. For at least six months, at least one of the signs of this group is observed in severity that does not correspond to this stage of the child's development. Children:
- often jump out with an answer without listening to the question;
- often cannot wait their turn in games or group situations;
- often interrupt or interfere with others (for example, interfering in a conversation or game);
- are often unnecessarily wordy, not responding adequately to social restrictions.

4. Onset of the disorder before the age of 7 years.

5. Severity of symptoms: objective information about hyperkinetic behavior must be obtained from more than one area of ​​continuous observation (for example, not only at home, but also at a school or clinic); Parents' stories about behavior at school may be unreliable.

6. Symptoms cause distinct impairments to social, academic, or work functioning.

7. The condition does not meet the criteria for general developmental disorder (F84), affective episode (F3), or anxiety disorder(F41).

Complaints and anamnesis

1. Attention disorders include:
- inability to maintain attention: the child cannot complete the task to the end, is not collected when it is completed;
- decrease selective attention, inability to concentrate on a subject for a long time;
- frequent forgetting what needs to be done;
- increased distractibility, increased excitability: children are fussy, restless, often switch from one activity to another;
- an even greater decrease in attention in unusual situations when it is necessary to act independently.

2. Impulsivity - the inability to establish causal relationships, as a result of which the child is not able to foresee the consequences of his actions:
- sloppy completion of school assignments, despite efforts to do everything right;
- frequent shouting from the place and other noisy antics during the lessons;
- “intervening” in the conversation or work of other children;
- inability to wait their turn in games, during classes, etc.;
- frequent fights with other children (the reason is not bad intentions or cruelty, but the inability to lose).
With age, there may be - urinary and fecal incontinence; in primary school- excessive activity in defending one's own interests, despite the requirements of the teacher (despite the fact that the contradictions between the student and the teacher are quite natural), extreme impatience.

3. Increased hyperactivity, behavioral disorder, intentional social disorders, antisocial personality disorder. In the senior nursery and adolescence- hooligan antics and antisocial behavior (theft, drug use, promiscuity). The older the child, the more pronounced and noticeable impulsivity and behavioral disorders.

Physical examinations: neurological status - impaired coordination in the form of impaired fine movements (tying shoelaces, using scissors, coloring, writing), balance (it is difficult for children to ride a skateboard and a two-wheeled bicycle), visual-spatial coordination (inability to play sports, especially with a ball); behavioral disorders; emotional disturbances(imbalance, irascibility, intolerance to failures); relations with others are violated both with peers and with adults; partial developmental delays despite normal IQ in the form of dyslexia, dysgraphia, dyscalculia. There may be sleep disturbances, enuresis.

Laboratory research: general analysis of blood and urine without pathology.

Instrumental research:

1. Electroencephalography.

Changes are characteristic: excessive slow-wave activity in the anterior-central leads; bilateral-synchronous, slow-wave activity in the posterior leads; the appearance of activity that is not characteristic of a given age; a large representation of theta rhythm in the background recording; high-amplitude EEG; the appearance of bursts of theta activity in the occipital leads.

2. CT and MRI data. Changes are characteristic: slight subatrophic changes in the frontal and temporal lobes; slight expansion of the subarachnoid space; slight expansion of the ventricular system; asymmetry of basal structures (the left caudate nucleus is smaller than the right one).

Indications for specialist consultations:

1. Psychologist for psychological diagnosis and correction.

2. Physical therapy doctor for the appointment of individual physiotherapy exercises.

3. Physiotherapist for prescribing physiotherapeutic procedures.

4. Oculist to determine the condition of the fundus.

5. Orthopedist to exclude orthopedic pathology.

6. Audiologist to determine the acuity of hearing.

Minimum examination when referring to a hospital:

General analysis blood;

General urine analysis;

ALT, AST;

Cal on i/g.

The main diagnostic measures:

1. Complete blood count (6 parameters).

2. Electroencephalography.

3. Examination by a psychologist, speech therapist.

4. CT scan brain.

5. Examination by an ophthalmologist.

Additional diagnostic measures:

1. Magnetic resonance imaging of the brain.

2. Examination by an orthopedist.

3. Examination by an audiologist.

Differential Diagnosis

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Treatment

Treatment tactics

Goals of conservative treatment:

1. Correction of the neuropsychic status of patients.

2. Provide the patient with social adaptation.

3. Determine the degree of conduct disorder and ensure the selection of therapy.

Non-drug treatment

Educational work for parents and the child, to explain the features of the disease, be sure to explain the meaning of the upcoming treatment. It is necessary to discuss general and particular issues of education, to acquaint parents with methods of reward, behavioral psychotherapy etc. If it is difficult for a child to study in a regular class, he is transferred to a specialized class (correctional). Optimization of the external conditions of the child's stay in the team, his stay in a small school group, preferably with self-service in the classroom, thoughtful seating of children.

Compliance with the daily routine, pedagogical correction, creation of psychological comfort;

Cognitive psychotherapy;

Classes with a psychologist;

exercise therapy in the group;

Massage of the cervical-collar zone;

Physiotherapy;

Conductive Pedagogy;

Lessons with a speech therapist.

Medical treatment

1. Methylphenidate is taken 1-3 times a day (depending on the form): once in the morning with prolonged forms (prolonged release), with an immediate release form - in the morning, at noon and, if possible, after school. One difficulty is that taking the drug too late in the day can disrupt sleep. The dose of methylphenidate is 10-60 mg / day. inside, the dose should be selected individually, based on the needs of a particular patient and his response to treatment. Taking the drug at 18 mg once a day, in the morning with a liquid (do not break, chew), followed by an increase of 18 mg weekly, but not more than 54 mg / day.

The selection of the drug is made until the maximum is reached. therapeutic effect or side effects will not develop - loss of appetite, irritability, epigastric pain, headache, insomnia (usually - when taken late). In the event of a paradoxical increase in symptoms or other adverse events, the dose of the drug should be reduced, and then only discontinued. Physical dependence on psychostimulants in children usually does not develop. Tolerance is also not typical; as a short-term phenomenon, it is possible at the beginning of treatment, but usually disappears when the dose is increased.

2. Antipsychotics: chlorprothixene, thioridazine are indicated for severe hyperactivity and aggressiveness.

3. Antidepressants for secondary depression: fluoxetine, melipramine.

4. Tranquilizers with the ineffectiveness of the above treatment: grandaxin, clorazepate.

5. Anticonvulsant normotimic drugs (phenytoin-difenin, carbamazepine and valproic acid) are also used.

6. In case of intolerance to psychostimulants, nootropic therapy is indicated: glycine, pantocalcin, noofen.

7. Antioxidant therapy: oxybral, actovegin, instenon.

8. Restorative therapy: B vitamins, folic acid, magnesium preparations.

Preventive actions:

Improving the quality of life;

Good drug tolerance;

Prevention side effects psychostimulants, anticonvulsants;

Pedagogical control;

Creation of psychological comfort in the family;

When conducting drug therapy- daily telephone communication with school staff, periodic discontinuation of medication to decide whether it is necessary to continue;

If drug therapy is ineffective, the program can be used behavioral therapy with the participation of psychotherapists, teachers-specialists.

Further management: dispensary registration with a neurologist at the place of residence, when taking psychostimulants, it is necessary to control the quality of sleep, for side effects; when taking antidepressants - ECG control with palpitations; when taking anticonvulsants - biochemical analysis blood - ALT, AST; creation of optimal conditions for normal learning, successful socialization of the child and education of self-control.

Basic medicines:

1. Methylphenidate - concerta, extended release tablets 18 mg, 36 mg, 54 mg

2. Fluoxetine hydrochloride 20 mg capsules

3. Chlorprothixene, tablets 0.015 and 0.05

4. Thioridazine (sonapax), dragee 0.01, 0.025 and 0.1

5. Convulex, drops for oral administration with dosing dropper, 300 mg/ml, 1 drop 10 mg, 1 ml = 30 drops = 300 mg

6. Konvuleks, tablets of prolonged action 300 and 500 mg

7. Carbamazepine tablets 200 mg

8. Vincamine (oxybral), capsules 30 mg

9. Actovegin, 80 mg ampoules

10. Pyridoxine hydrochloride, ampoules, 1 ml 5%

11. Magne B6 tablets

12. Cyanocobalamin, 1 ml ampoules 200 mcg and 500 mcg

13. Thiamine bromide, ampoules 1 ml 5%

14. Clorazepate (tranxen), capsules 0.01 and 0.005

Additional medicines:

1. Grandaxin, 50 mg

2. Mebicar tablets 300 mg

3. Imipramine (melipramine), 25 mg

4. Tanakan tablets 40 mg

5. Pantocalcin, tablets 0.25

6. Neuromultivit, tablets

7. Folic acid, tablets 0.001

8. Vinpocetine (Cavinton), tablets 5 mg

9. Glycine tablets

10. Noofen, tablets 0.25

11. Difenin, tablets 0.117

Treatment effectiveness indicators:

1. Increasing the level of active attention.

2. Improve behavior.

3. Reducing the level of impulsiveness, aggressiveness.

4. Improving school performance, independence.

Hospitalization

Indications for planned hospitalization: impaired attention, disinhibition, motor clumsiness, forgetfulness, inattention to details, lack of independence, purposefulness and concentration, school maladaptation and academic failure, dissociality, secondary depressive manifestations.

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 239 of 04/07/2010)
   1. "Neurology" edited by M. Samuels, 1997 Petrukhin A.S. Neurology childhood, Moscow 2004 "Psychiatry" edited by R. Shader, 1998 "Clinical Psychiatry" edited by V.D.Vid, Yu.V.Popov. SPb. - 2000.

Information

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What is Hyperkinetic Disorders

This group of disorders is characterized by an early onset; a combination of overly active, poorly modulated behavior with pronounced inattention and lack of perseverance in completing any tasks. Behavioral features are manifested in any situations and are constant in the time interval.

Hyperkinetic disorders usually occur in the first 5 years of life. Their main features are the lack of perseverance in cognitive activity, the tendency to move from one task to another without completing any of them; excessive but unproductive activity. These characteristics persist through school age and even into adulthood. Hyperkinetic children are often reckless, impulsive, prone to getting into difficult situations due to rash actions. Relationships with peers and adults are broken, without a sense of distance.

Secondary complications include dissocial behavior and reduced self-esteem. There are often accompanying difficulties in mastering school skills (secondary dyslexia, dyspraxia, dyscalculia and other school problems).

Prevalence

Hyperkinetic disorders are several times more common in boys than girls (3:1). In elementary school, the disorder occurs in 4-12% of children.

Symptoms of Hyperkinetic Disorders

The main signs are attention disorders and hyperactivity, which manifest themselves in various situations - at home, in children's and medical institutions. Frequent change and interruption of any activity is characteristic, without attempts to complete it. Such children are overly impatient, restless. They can jump up during any work, talk excessively and make noise, fidget... Comparison of the behavior of such children with other children of this age group is diagnostically significant.

Associated clinical characteristics: disinhibition in social interaction, recklessness in dangerous situations, thoughtless violation of social rules, interruption of classes, thoughtless and incorrect answers to questions. Learning disorders and motor clumsiness are quite common. They should be coded under (F80-89) and should not be part of the disorder.

Most clearly, the clinic of the disorder manifests itself at school age. In adults, hyperkinetic disorder may manifest as dissocial personality disorder, substance abuse, or another condition with impaired social behavior.

Diagnosis of Hyperkinetic Disorders

Most difficult to differentiate from behavioral disorders. However, if most of the criteria for hyperkinetic disorder are present, then the diagnosis should be made. When there are signs of severe general hyperactivity and conduct disorders, the diagnosis is hyperkinetic conduct disorder (F90.1).

The phenomena of hyperactivity and inattention may be symptoms of anxiety or depressive disorders (F40 - F43, F93), mood disorders (F30-F39). The diagnosis of these disorders is based on their diagnostic criteria. Dual diagnosis is possible when there are separate symptoms of hyperkinetic disorder and, for example, mood disorders.

The presence of an acute onset of a hyperkinetic disorder at school age may be a manifestation of a reactive (psychogenic or organic) disorder, a manic state, schizophrenia, or a neurological disease.

Which Doctors Should You See If You Have Hyperkinetic Disorders

Psychiatrist

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