By Dr: Samir M Al-Minshawy

Lecturer of Neuropediatrics

Minia University

Psychology Vs Psychiatry

Psychology is the study of people: how they think,act, react and interact. Psychology is concerned withall aspects of behavior, thoughts, feelings andmotivation underlying such behavior.

Psychiatry is the study of mental disorders and theirdiagnosis, management and prevention.

Dr: Emil Kraepelin(1856 – 1926): the founder of modernpsychiatry, who brought up the specialty of child psychiatrystarting with the neonatal period and extending throughadolescence.

4000-years-old Luxor Temple!

The Abu el-Haggag Mosque

Mental disorders have been recognised in Egypt formillennia; 5000 years ago, they were considered to bephysical ailments of the heart or uterus, as describedin the Ebers and Kahun papyri. These disorderscarried no stigma, as there was no demarcation thenbetween psyche and soma.

In the 14th century – 600 years before similarinstitutions were founded in Europe – the firstpsychiatric unit was established, in Kalaoon Hospitalin Cairo.

Interactive Children

1- The right of having known and contracted (one) lineage:

2- The right to have a healthy and chaste womb environment

3- The right to have a strong genetic origin

4- The right to have a true faith

5- The right to get into heaven

6- The right of equality with other fetuses

7- The right to have a normal social life

8- The right to maintain fetus life

9- The right to enjoy health life within womb

10- Maintaining fetus good and benefit

11- Temporary hold of penalties for the pregnant

12- Maintaining fetus's financial rights

13-Honorable Islamic precedence

Infanticide is explicitly prohibited by the Quran.

Esposito, John L. (editor) (2004). NY: The Oxford Dictionary

of Islam, p. 138. ISBN 978-0-19-512559-7 .

http://galleryhip.com/egypt-children.html

Fetal Psychology

“Babies have been trying for centuries to convince usthey are like us : sensing, feeling, thinking. With newwindows to the womb studies uncovered previouslyhidden talents of both prenates and newborns.

Basically, we should address and stress on:

The roots of human behavior begin to develop early -just weeks after conception, may before a womantypically knows she is pregnant.

Structural and functional brain development is highlyrelated to behavior and cognitive development assupported by MRI studies and фффany significantalterations in the vulnerable early fetal life may bepermanent and linked to childhood and adultpsychopathology.

Magnetoencephalography (MEG) can be effectivelyused to record fetal and neonatal cognitiveabilities/functions by recording completely non-invasively the magnetic fields produced by the activeneurons in the brain.

Prenatal Development

Mixed Messages from Mom

At 3-5 weeks, brain begins to develop.

At 9 weeks, the brain allows fetus to bend its body,hiccup, and react to loud sounds. At week 10, it movesits arms, "breathes" amniotic fluid in and out, opensits jaw, and stretches. Before the first trimester isover, it yawns, sucks, and swallows, as well as feels andsmells. By the end of the second trimester, it canhear; toward the end of pregnancy, it can see.

Factors affecting prenatal brain development:

Genetic role Maternal health and nutrition Maternal age and weight Maternal immunity and infections Prenatal exposure to teratogens (drugs, chemicals and irradiation, etc..) and

psychoactive drugs Maternal emotional state and stress (working mother) Gonadal hormones Socioeconomic factors Others

Predisposing factors for early brain injury Prematurity Low birth weight (LBW) infants Small for gestational age (SGA) infants Adverse neonatal events

Prenatal factors have long-lasting consequences onlater mental health. Maternal smoking is associatedwith offspring ADHD and antisocial behavior. Itshowed a dose-response relationship with persistentcriminal behavior in male offspring, after controllingfor demographic, parental, and perinatal risk factors.

Lower birth weight and under nutrition linked towide range of psychopathology, including depression,psychosis and ADHD. The mechanism may beplacental dysfunction, anoxia, maternal cortisol,environmental toxins such as nicotine and carbonmonoxide that cross the placental barrier, and earlyprogramming effects..

Untreated maternal depression was associated withslower fetal growth. preterm birth.

The Fetal Senses

Sensitivity to Touch

Touch, the first sense, beginning in just before 8 weeks and completed by 32weeks.

Tasting and Smelling

Tasting begins at 14 weeks. Swallowing increases with sweet tastes anddecreases with bitter tastes. The nose develops between 11 and 15 weeks.Amniotic fluid provides tastes and odors crossing the placenta by permittingdirect access to receptors of several chemosensory systems. So newborns aredrawn to the odor of breast milk.

Listening and Hearing

Although amniotic fluid, embryonic membranes, uterus, and the maternalabdomen—barriers, fetus receives sound. A mother's voice and music aretransmitted to the womb. "Reactive listening begins at 16 weeks, eight weeksbefore the ear is structurally complete at about 24 weeks.

Development of Vision

Although, eyelids remain closed until the 26th week, thefetus responds to light with heart rate accelerations andmay use some aspect of "vision" to detect the location ofneedles entering the womb, either shrinking away fromthem or turning to attack the needle barrel with a fist. Also,twins have no trouble locating each other and touchingfaces or holding hands!

The Fetal Movement

Begins with the first heartbeat at about 3 weeks afterconception. Between week 6 and 10, fetal bodies burst intomovements. Awake or asleep, it moves 50 times or more perhour, serving as tactile stimulation for itself.

The Senses in Action

skin and bones contribute to hearing, and vision seemsfunctional even with fused eyelids. Babies are dreaming asearly as 23 weeks g.a. when REM sleep is observed.

Fetal Learning

Fetus can learn and remember by habituation. Within hours ofbirth, a baby prefers its mother's voice to a stranger's, suggestingit must have learned and remembered the voice. A newbornprefers a story read to it repeatedly in the womb by responding tothe rhythm of voices and stories, not their words. the humanfetus is an active participant in its own development and iscollecting information for life after birth. Babies begin learninglanguage in the womb. This proved that by about 26 weeks ofgestation, this baby had already acquired certain features of its"mother tongue."

Fetal Personality

Babies are born with characterized differences. Just when andhow the behavioral traits originate in the womb is now thesubject of intense study, may due to mother's sleep/wake cycles,eating patterns, movements and personality.

Fetal Emotions

As in adults, external behavior is associated withinternal emotions like sadness, fear, pain, anger, rageand pleasure . Audible crying is rare as it requires airin trachea. However, it occurred in response to ruptureof a membrane, manual displacement of the head orthe attachment of electrodes for internal monitoring.

Facial expressions, particularly smiling and otherfacial expressions which occuring in REM sleepindicating expressions of private pleasure.

Fetal Cry

Fetal Smile

Maternal fetal attachment

It is the extent to which women engage in behaviorsthat represent an affiliation and interaction with theirunborn child, it begins prenatally.

Positively affected by many factors including themother’s emotional state, environment, social supportsystem, as well as negatively affected by factors, such assubstance abuse and anxiety.

Emotionally disturbed women have infants who areirritable, poor sleepers, with lower mental and motorskills, ADHD, autism and psychosis.

Increasing abortion and birth complications with fear,anxiety, guilt, difficult acceptance and poorattachment.

Studies have also attributed that toneuroendocrinological disturbances, particularlycatecholamines crossing the placenta, biochemicallyprovoke the physiological reaction to anxiety and fearin the fetus.

Steps to Bond with Your Unborn Baby1. Understand what preborn babies may hear. Prenate are aware of and affected by what’s going on in the

outside world.2. Know that sound may stimulate a six-month-old fetus. A six-month-old fetus can move his body to the rhythm of his

mother’s speech. Babies seem agitated by so loud sounds.3. Understand what your preborn baby may sense. Fetus can perceive different tastes and sights.4. Understand what your preborn baby may think. Mother’s thoughts affect the emotional life of her preborn baby.5. Consider the long-term effects of your emotional life. Anxious mothers (not mild stress) produce anxious babies.

Mothers who felt no attachment to their babies were more likelyto have children who had emotional problems..

6. Grow a healthy baby. Guard against polluted thoughts! Relax! Take reasonable

measures to rid your life of tension, take time to rest and revel inpositive emotions . Talk to, sing to and share affectionatethoughts with your baby.

Neonatal PsychologyHow do infants experience the world? Infants are born with innate primary reflexes which are

unlearned responses to stimuli and disappear later. Indicate whether the newborn’s nervous system is working

properly.How does love develop between mother and neonate? Harry Harlow evaluated whether feeding or contact was

more important. His research showed that the need for affection created a

stronger bond between mother and infant than didphysical needs (food) suggesting that the development of achild’s love was emotional rather than physiological

'kangaroo care‘ allows more attachment which may provideadditional physiological and neurodevelopmental benefitsin neonates

Myths about Newborns

1. Babies Don't Feel

2. Very Poor Brains

3. Assembly-Line Brain

4. Babies Can't Think

5. No Sense of Self

6. Babies Don't Need Their Mothers

7. The Age Myth

Attachment

Maternal-Infant Interaction: is a strong, long-lasting emotional connection that is “person-specific” and is enduring across time

Dynamic interactive process

Represents the prototype for all other socialrelationships.

Behavioral and Cognitive Activity of Newborns

Within hours after birth, human -even premature-neonates show significantly increased preferences for theirmothers voice , smell, and facial features over those of astranger. actively perceive, learn, and organize information.

Holy Quran recitation can be considered a complementaryand supportive care for preterm newborns (Eskandari et al.,2012).

Increased Sensitivity to Pain in NeonatesThe traditional view that neonates were relatively insensitive

to pain was contradicted.

Maternal Separation

Prolonged maternal separation leads to the development ofexaggerated hormonal responses and alteredneurotransmitter release which may lead to long term effects.

Adverse neonatal experiences (many of which arepreventable) may lead to early brain injury andpredispose to late abnormal behavior. The major

proposed mechanisms of brain injury are hypoxia-

ischemia and inflammation.

Sedatives given in the absence of painful interventionswere noted to increase the risk for drug abuse.

Invasive procedures in neonates cause markedfluctuations in intracranial pressure leading to earlyintraventricular hemorrhage or periventricularleukomalacia and analgesia lessen that cascade.

Prematurity and low birth weight Giving high risk for brain injury, disturbances

in brain maturation and neurobehavioral sequale. Preterm birthwas significantly associated with increased risk of psychiatrichospitalization in adulthood with nonaffective psychosis, bipolaraffective disorder, depressive disorder, eating disorder, drugdependency, or alcohol dependency

The developing brain, particularly the periventricular whitematter, is vulnerable to cytotoxic and hypoxic/ischemic injury,which increase the risk for abnormal cognitive and motorfunctioning. Ex-premature infants have more educational,behavioral and emotional difficulties later as compared to theirex-full term peers.

Early life stress: As mother separation, poor family functioning, low social

support, and caregiver psychological distress result inabnormalities in brain structure and function which areassociated with deficits that may persist for years after the stressis removed.

Breast feeding

Benefits are as greater as longer the baby isbreastfed.

Improving their children’s cognitive development ofpreterm and term infants.

Breast milk constituents promote healthy neuralgrowth and white matter development

Breastfeeding may be associated with a lower riskfor psychopathology for mother and infants in laterlife.

Research points to the importance of breastfeedingfor promoting close mother infant contact andsocial-emotional development.

Parenting is an Art

Very Early Parenting Starts Before Conception

For strong interpersonal bonds: Understanding the needs of the other Providing care and protection Preoccupation with the interests and wants of the other. parenting is a subset of caregiving or social behaviors and

thoughts that are conserved, and have a predictable time courseand characteristic content.

Transition to parenthood involves a set of highly conservedbehaviors and mental states, reflecting both genetic role andearly life experience.

Parenting behaviors play a critical role in the child's behavioraldevelopment it shapes infants’ current and future behavior,provides infants with their first social experiences, formstemplates of what they can expect from others and how to bestmeet others’ expectations.

Parenting of mothers and fathers may be independently andinteractively related to child outcomes. We are need for actualwise fatherhood.

Parenting is regulated by key hormones and neurotransmitters.

I need both of youThat is good for me and for you