What to do in the first application in children?

What to do in the first application in children?

Content Summary

NPISTANBUL Hastanesi ve Üsküdar Üniversitesi Feneryolu ve Etiler Sağlık Uygulama ve Araştırma Merkezleri, sizlere ve sevdiklerinize tanı koyma ve müdahale etme konusunda yardımcı olacak kaynaklar sunmaktadır. Temel yaklaşımları kapsamlı muayene ve nöropsikolojik tarama ile tanıyı netleştirmek, ölçüm yöntemlerine dayalı tedavi planı oluşturmak ve beyin kanıtlarını takip ederek tedavi uygulamak üzerinedir. İlk kez çocuk ve ergen psikiyatri polikliniğine başvuran hastalar, psikiyatrik (ve gerekirse nörolojik) muayeneden geçerler. Özellikle daha önce tedavi görmüş ancak fayda görmemiş veya tedaviye dirençli hastalığı olanlar tanı aşamasında detaylı değerlendirmeye tabi tutulur. Değerlendirme; nöropsikolojik (planlama, dikkat, konsantrasyon, hafıza vb. beyin fonksiyonlarını ölçen testler), konuşma profili (konuşma gecikmesi, kekemelik ve telaffuz problemleri için konuşma ve dil terapisti değerlendirmesi), kişilik profili (MMPI ve Rorschach gibi testlerle kişilik özellikleri değerlendirmesi), kardiyovasküler (tansiyon ve nabız ölçümü, EKG), nörogörüntüleme (QEEG, volumetrik kranial MRI, gerektiğinde PET, SPECT, fonksiyonel MRI), uyku laboratuvarı (uyku bozukluğu veya epilepsi şüphesi olanlarda polisomnografi), nörobiyokimyasal (vitamin, mineral, demir, kan şekeri, karaciğer ve böbrek fonksiyonları, enfeksiyonlar), nöroinflamatuar (romatizmal hastalık veya bağışıklık sistemi hastalıkları için ASO, CRP, otoantikorlar), nöroendokrin (tiroid, kortizol, prolaktin gibi hormon seviyelerinin kontrolü), toksik tarama (beyin fonksiyonlarını etkileyen madde kullanımı) ve klinik farmakogenetik (ilaç düzeylerinin ölçümü ve farmakogenetik analiz) değerlendirmelerini içerir.

NPISTANBUL Hospital and Üsküdar University Feneryolu and Etiler Health Practice and Research Centers within NPGRUP offer resources to help you and your loved ones understand and intervene.

Our basic approach

  1. First, to clarify the diagnosis through comprehensive examination and neuropsychological screening,
  2. Then make a treatment plan based on measurement methods,
  3. To apply treatment by following the brain evidence.

Patients presenting to our Child and Adolescent Psychiatry outpatient clinic for the first time first undergo a psychiatric (and, if deemed necessary, an additional neurological) examination.
Patients presenting to our Child and Adolescent Psychiatry outpatient clinic for the first time (especially those who have received treatment before but have not benefited from it, and those with treatment-resistant diseases) are subjected to a detailed evaluation during the diagnostic phase.

Neuropsychological Examination

Children and adolescents with learning and attention problems are administered tests to measure brain functions (planning, attention, concentration, memory, etc.) if these tests have not been administered within the last six months. For this purpose, computerized tests such as SPM; COG; DAUF; NVLT or a special group of tests administered by interview technique are used.

Speech Profiling

Children and young people with speech delay, stuttering and pronunciation problems are evaluated by the Speech and Language Therapy Specialist, necessary tests and examinations are performed, and the appropriate therapy method is planned according to the patient's needs for the detected speech problem.

Personality Profiling

When necessary and in appropriate patients, tests such as MMPI and Rorschach are used to assess personality traits. It is understood whether the patient has a compulsive personality structure that causes intense anxiety or perception and/or thought disorder and thus leads to impairment in brain functions in the secondary process. The findings are used in the treatment process.

Cardiovascular Evaluation

Blood pressure and pulse rate measurements are performed in every patient. Electrocardiography (ECG) must be performed in patients with cardiovascular complaints, those who are taking medications that carry cardiac risk and those who will start new medications.

Neuroimaging

If not performed within the last six months, at least one of the Quantitative EEG [QEEG], Volumetric Cranial MRI examinations is performed to examine in detail whether there is a deterioration in the structure or functioning of the brain. If necessary, PET, SPECT, Functional MRI can be performed for further examination. Cranial MRI or Computed Tomography is performed in patients with a complaint related to mental functions/suggestive of a neurological disease, if it has not been performed within the last six months. Which imaging technique will be used is determined after the neuropsychiatric examination.

Sleep Laboratory

In patients with suspected sleep disorder or epilepsy, Polysomnography, EEG with 12/24 hour Video Monitorization all night can be performed, which is thought to help the diagnosis. The patient's sleep profile is obtained and its relationship with the psychiatric/neurologic picture is investigated.

Neurobiochemical Evaluation

When deemed necessary, children and young people undergo blood and urine tests to check for vitamins, minerals, iron in the blood (anemia), blood sugar irregularities, liver and kidney function, and the presence of widespread or brain-affecting infections that may affect brain function.

Neuroinflammatory Evaluation

When necessary, children and young people are tested for ASO, CRP, various autoantibodies, etc., which indicate the presence of a rheumatic disease or a disease affecting the immune system and brain functions.

Neuroendocrine Evaluation

If the patient's complaints (e.g. If the patient's complaints (e.g. weight change, decreased energy, palpitations, tremors, memory-attention problems...etc.) raise suspicion for certain diseases, weight measurement is performed and the levels of hormones such as Thyroid, Cortisol, Prolactin, which accompany psychiatric pictures and affect brain functions, are definitely checked.

Toxic Screening

In people who use drugs or addictive substances that affect brain function, these substances are tested in the blood/urine. It is repeated at the beginning of treatment and regularly during follow-up.

Clinical Pharmacogenetic Evaluation

In children or adolescents taking medication, higher blood levels of medication above therapeutic levels or drug interactions can lead to impaired brain function. To detect this, the blood levels of the drugs used (TDM) are measured. In patients who do not respond to treatment, pharmacogenetic analysis is performed and patient-specific treatment options are determined.

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CreatorNP Istanbul Hospital Editorial Board
Updated At16 January 2025
Created At02 August 2023
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