psychomotor retardation

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Information about psychomotor retardation
Health & Medicine

Published on December 27, 2008

Author: NTavakoli

Source: slideshare.net

 

Psychomotor Retardation Presented by : Yasrin Berangi M.D. Guilan University of Medical Sciences

DEFINITION The diagnosis of psychomotor retardation diferential (developmental delay) is quite different from that of psychomotor regression.

The diagnosis of psychomotor retardation diferential (developmental delay) is quite different from that of psychomotor regression.

Slow progress in the attainment of developmental milestones may be caused by either static or progressive encephalopathy. But psychomotor regression indicate a progressive disease of nervouse system.

Slow progress in the attainment of developmental milestones may be caused by either static or progressive encephalopathy.

But psychomotor regression indicate a progressive disease of nervouse system.

Developmental delay Two important questions must be asked: 1) Is delay restricted to spescific areas of development or is it global? 2) Is there only developmental delay, or is there also developmental regression?

Two important questions must be asked:

1) Is delay restricted to spescific areas of development or is it global?

2) Is there only developmental delay, or is there also developmental regression?

The Denver Developmental Screening Test(DDST) Efficient, reliable Assesses: Personal-social Fine motor adoptive language gross motor

Efficient, reliable

Assesses: Personal-social

Fine motor adoptive

language

gross motor

Language Delay Vocalization of vowels: first month Laughing & squealing: 5 mo. Articulating consonants: 6 mo. Specific use of “mama” & “dady” : 1 years To combine at least 2 words: 2years Understanding more than 250 words & follow many simple verbal directions:2 years

Vocalization of vowels: first month

Laughing & squealing: 5 mo.

Articulating consonants: 6 mo.

Specific use of “mama” & “dady” : 1 years

To combine at least 2 words: 2years

Understanding more than 250 words & follow many simple verbal directions:2 years

Hearing impairment The major cause of delay of speech development May occure with global developmental retardation: rubella emberyopathy CMV disease neonatal meningitis kern icterous genetic disorders

The major cause of delay of speech development

May occure with global developmental retardation:

rubella emberyopathy

CMV disease

neonatal meningitis

kern icterous

genetic disorders

Hearing loss should be suspected Global retardation Retarded childeren fail to imitate sounds Excessive gesturing & staring at the lips of people who are talking

Global retardation

Retarded childeren fail to imitate sounds

Excessive gesturing & staring at the lips of people who are talking

Infantile autism Caused by: Abnormal brain developmental Clinical features: Failure of language developmental impairment of interpersonal relationships Restricted activities Onset before 3 years

Caused by:

Abnormal brain developmental

Clinical features:

Failure of language developmental impairment of interpersonal relationships

Restricted activities

Onset before 3 years

Clinical features Major criteria : Failure of language developmental impairment of interpersonal relationships Restricted activities Onset before 3 years Others:IQ<70 Stereotyped behavior

Major criteria : Failure of language developmental impairment of interpersonal relationships

Restricted activities

Onset before 3 years

Others:IQ<70

Stereotyped behavior

Diagnosis Clinical Can not be comfirmed by lab. Tests

Clinical

Can not be comfirmed by lab. Tests

Treatment Failure of language development is most likely to bring medical attention & correlates best with outcome Failure to develop language before age 5 have the worth outcome Naltrexone Behavior modification techniques

Failure of language development is most likely to bring medical attention & correlates best with outcome

Failure to develop language before age 5 have the worth outcome

Naltrexone

Behavior modification techniques

Delayed motor development Infants with delayed gross motor development but Nl. Language & social skills are Often hypotonic & may have a Neurovascular disease.

Infants with delayed gross motor development but Nl. Language & social skills are Often hypotonic & may have a Neurovascular disease.

Isolated delay in motor function is also caused by ataxia, mild hemiplagia, mild paraplagia & mild cerebral palsy

Isolated delay in motor function is also caused by ataxia, mild hemiplagia, mild paraplagia & mild cerebral palsy

Global developmental delay Static encephalopathy : antenatal/perinatal disturbance Underlying genetic disease

Static encephalopathy : antenatal/perinatal disturbance

Underlying genetic disease

Findings in progressive disease Affected family member Parental consanguinity Organomegaly Absent DTR

Affected family member

Parental consanguinity

Organomegaly

Absent DTR

Screening test MRI: detect malformations Evidence of perinatal disease Provides diagnosis that ends uncertainty

MRI: detect malformations

Evidence of perinatal disease

Provides diagnosis that ends uncertainty

Mental retardation Chromosomal abnormality Cerebral malformations Intrauterine infections Perinatal disorder

Chromosomal abnormality

Cerebral malformations

Intrauterine infections

Perinatal disorder

Chromosal structure or number : most comon cause of severe mental retardation

Chromosal structure or number :

most comon cause of severe mental retardation

Clinical indication for chromosome analysis

Genitourinary ambiguous genitalia polycystic kidney

ambiguous genitalia

polycystic kidney

Head & neck High nasal bridge Hyper/hypo telorism Microphtalmia Mongoloid slant Occipital skull defect Small mandible Small or fish mouth(hard to open) Small or low set ears Upward slant of eyes Web neck

High nasal bridge

Hyper/hypo telorism

Microphtalmia

Mongoloid slant

Occipital skull defect

Small mandible

Small or fish mouth(hard to open)

Small or low set ears

Upward slant of eyes

Web neck

Limbs Abnormal dermathoglyphic Low set thumb Overlapping fingers Polydactily Radial hypoplasia Rocker bottom feet

Abnormal dermathoglyphic

Low set thumb

Overlapping fingers

Polydactily

Radial hypoplasia

Rocker bottom feet

Fragile X Synd. The most common cause of severe mental retardation The name drives from a site at the Xq 27.3

The most common cause of severe mental retardation

The name drives from a site at the Xq 27.3

Typical synd. Moderate retardation(IQ:40_55) Behaivor problems: autism or attention disorders Somatic abnormalities:long face,enlarged ears,macro_orchidism

Moderate retardation(IQ:40_55)

Behaivor problems: autism or attention disorders

Somatic abnormalities:long face,enlarged ears,macro_orchidism

Diagnosis Chromosome analysis

Chromosome analysis

treatment High dose folic acid No improvement of IQ but behavioral improvment

High dose folic acid

No improvement of IQ but behavioral improvment

Cerebral malformation 3% of all childeren have at least 1 major malformation but the responsible etiologic factors can be identified in only 20% of cases

3% of all childeren have at least 1 major malformation but the responsible etiologic factors can be identified in only 20% of cases

causes Exposure of emberyo to infectious or toxic agants during first week Alcohol Lead Prescription drugs cocaine

Exposure of emberyo to infectious or toxic agants during first week

Alcohol

Lead

Prescription drugs

cocaine

Cerebral malformation should be susspected in any retarded child with: dysmorphic, malrotation of organs, abnormality of head size & shape CT is satisfactory to show but MRI is the better method

Cerebral malformation should be susspected in any retarded child with: dysmorphic, malrotation of organs, abnormality of head size & shape

CT is satisfactory to show but MRI is the better method

Intrauterine infection The most common: HIV CMV

The most common:

HIV

CMV

Congenital syphilis Cases of congenital syphilis have increased scince 1988 2/3 infected newborns of asymptomatic More common features: condylomata lata,periostitis,osteochondritis,persistent rhinorrhea, maculopapular rash

Cases of congenital syphilis have increased scince 1988

2/3 infected newborns of asymptomatic

More common features: condylomata lata,periostitis,osteochondritis,persistent rhinorrhea, maculopapular rash

Onset of neurologic disturbances: after 2 years Including: nerve deafness & mental retardation

Onset of neurologic disturbances: after 2 years

Including: nerve deafness & mental retardation

Hutchinson triad nerve deafness interstitial keratitis peg shaped upper insisors

nerve deafness

interstitial keratitis

peg shaped upper insisors

Diagnosis Non treponemal Ab tests (VDRL,RPR):screening FTA-ABS: confirmation AIDS should be suspected in every child with congenital syphilis

Non treponemal Ab tests (VDRL,RPR):screening

FTA-ABS: confirmation

AIDS should be suspected in every child with congenital syphilis

Treatment Intravenous crystalline penicilline G,100,000_150,000 U/kg/day in 6 devided dose every 8_12 h, for 10_14 d. Intramascularly procaine penicilline G 50,000 U/kg/daily _10-14 d

Intravenous crystalline penicilline G,100,000_150,000 U/kg/day in 6 devided dose every 8_12 h, for 10_14 d.

Intramascularly procaine penicilline G 50,000 U/kg/daily _10-14 d

CMV Transmitted sexually Pregnancy may cause reactivation of maternal infection 1-2% culture + :0.05 % symptoms +

Transmitted sexually

Pregnancy may cause reactivation of maternal infection

1-2% culture + :0.05 % symptoms +

Clinical features Skin rash Hepatosplenomegaly Juandice Chorioretinitis microcephaly

Skin rash

Hepatosplenomegaly

Juandice

Chorioretinitis

microcephaly

Diagnosis Analysis of urine & CSF analysis Serologic tests

Analysis of urine & CSF analysis

Serologic tests

Treatment Gancylovir No treatment can reverse the malformation

Gancylovir

No treatment can reverse the malformation

Rubella

Clinical Features A multisystem disease characterized by: Intrauterine growth retardation Cataract Chorioretinitis Congenital heart disease Sensorineuoral deafness Thrombocytopenia Rash Neurologic features:Lethargy,Hypotonia,seizure

A multisystem disease characterized by:

Intrauterine growth retardation

Cataract

Chorioretinitis

Congenital heart disease

Sensorineuoral deafness

Thrombocytopenia

Rash

Neurologic features:Lethargy,Hypotonia,seizure

Diagnosis : Clinical Treatment : No treatment

Diagnosis : Clinical

Treatment : No treatment

Toxoplasmosis Transmission: by primary maternal infection during pregnancy Highest risk: last trimester The most serious sequelae: first trimester

Transmission:

by primary maternal infection during pregnancy

Highest risk: last trimester

The most serious sequelae: first trimester

 

Clinical features Multisystem involvement at birth: Fever,rash, hepathosplenomegaly,juandice,thrombocytopenia Neurologic dysfunction:seizure,altered state of consciousness,ICP

Multisystem involvement at birth: Fever,rash, hepathosplenomegaly,juandice,thrombocytopenia

Neurologic dysfunction:seizure,altered state of consciousness,ICP

Congenital toxo. Hallmark: Hydrocephalus Chorioretinitis Intracranial calcification

Hallmark:

Hydrocephalus

Chorioretinitis

Intracranial calcification

Diagnosis Sabin-feldman dye test: standard for dignosis ELISA: IgM-specific Ab to Toxo. In amblical cord blood: show passive infection IgG specific Ab show active infection

Sabin-feldman dye test: standard for dignosis

ELISA: IgM-specific Ab to Toxo. In amblical cord blood: show passive infection

IgG specific Ab show active infection

Treatment Pregnant: Spiramycine Fetal documented infection: pyrimethamine & sulfadoxine/sulfadiazine Newborn:pyrimethamine(0.5mg/kg/dose)BID/for 1y. Sulfadizine(0.25mg/kg/dose) BID/for 1y. Newborns with high prt. In CSF / chorioretinitis: Prednisone(1_2 mg/kg/day)

Pregnant: Spiramycine

Fetal documented infection: pyrimethamine & sulfadoxine/sulfadiazine

Newborn:pyrimethamine(0.5mg/kg/dose)BID/for 1y.

Sulfadizine(0.25mg/kg/dose) BID/for 1y.

Newborns with high prt. In CSF / chorioretinitis:

Prednisone(1_2 mg/kg/day)

Thanks for your attention Special thanks to NargessTavakoli M.D .

Thanks for your attention

Special thanks to

NargessTavakoli M.D .

 

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