“W dziecięcej psychiatrii źle się dzieje” – alarmują
kolejne tytuły w prasie i na portalach w Internecie. Zamykane są kolejne oddziały,
brakuje specjalistów. Skąd to zapotrzebowanie? Czy psychiatra dla dziecka to
konieczność?
Przede wszystkim zmieńmy myślenie, że to wstyd
korzystać z porad tych specjalistów. Wszak bez zażenowania chodzimy do
kardiologa, alergologa czy stomatologa. To lekarze ciała, a od psyche mamy
psychiatrę, psychologa i psychoterapeutę.
Psychiatra jest
lekarzem, kończy studia medyczne, robi specjalizację oraz staż na psychiatrii.
Jego działania to: diagnoza oraz leczenie pacjentów z zaburzeniami i chorobami
psychicznymi. Może również (w przeciwieństwie do psychologa) przepisywać leki
wspomagające leczenie zaburzeń. Wiedza medyczna pozwala mu wskazać przyczynę
zaburzeń psychicznych i wytypować najwłaściwsze kompleksowe leczenie
(farmakologiczne i pozafarmakologiczne). Psychiatra dziecięcy diagnozuje
choroby i zaburzenia psychiczne wieku dziecięcego. Należą do nich m.in.
zaburzenia lękowe, spektrum autyzmu, ADHD, schizofrenia, zaburzenia łaknienia,
choroba afektywna dwubiegunowa, zaburzenia somatyczne, zaburzenia depresyjne.
Ten artykuł czytasz bezpłatnie dzięki "Westfield Arkadia"
Wypróbuj naszą prenumeratę i zyskaj więcej. Od teraz bez reklam . Przetestuj i zrezygnuj kiedy chcesz.
Psycholog może być doktorem (to stopień naukowy),
ale lekarzem nie jest. Kończy studia magisterskie (5-letnie). Może także zrobić
specjalizację zawodową (psychologia kliniczna dziecka, psychologia kliniczna człowieka
dorosłego, dla biegłych sądowych). Pole zainteresowań psychologa to zjawiska międzyludzkie
i aspekty funkcjonowania człowieka we współczesnym społeczeństwie. Psycholog
zajmuje się udzielaniem wsparcia i pomocy psychologicznej, diagnozowaniem
psychologicznym, opiniowaniem. Może pracować w poradniach, w szkołach, w
klubach sportowych, w różnego typu organizacjach sądach, zakładach pracy i in.
Niektórzy kończą dodatkowe 4-letnie szkolenia i uzyskują uprawnienia do
prowadzenia psychoterapii.
Czasami rodzice nie wiedzą gdzie się udać, gdy “coś
się dzieje dziwnego z dzieckiem”. Przez lata potomek był miły, wesoły,
kontaktowy, aż tu nagle okazuje się, że jest agresywny, chamski, ma coraz
gorsze oceny, lekceważy wszystko i wszystkich… Niektórzy powiedzą, że to “bunt
rozwojowy”. Ale czy zawsze? Niestety, nie. To, co widzimy, co wręcz rzuca się w
oczy, to złość i agresywne zachowania. Skąd te zmiany? Co się za tymi zachowaniami
kryje? W ten niezrozumiały dla nas sposób przywoływane są niezaspokojone
potrzeby. Jest to także wołanie o pomoc, gdy dziecko nie radzi sobie z trudnymi
emocjami. Za tym “czubkiem góry lodowej” złości, ukryte bywają: żal, strach,
zranienie, bezsilność, odrzucenie, wstyd i wiele innych odczuć. Ten widoczny
“czubek” może być sygnałem, że dziecko nie ma zaspokojonej jakiejś potrzeby,
np.: bezpieczeństwa, przynależności, szacunku, bliskości. Młody człowiek
szamocze się ze swymi emocjami, czuje się niezrozumiany przez bliskich i
otoczenie, zaszczuty i zastraszany przez rówieśników. Nakręca się spirala
bezradności, buntu, agresji. Aż któregoś dnia dochodzi do tragedii. Młody
organizm “pęka”… Wielu zapyta “depresja u dzieci?”. Tak, niestety, coraz więcej
dzieci ma zdiagnozowaną depresję, a przecież nie wszystkie trafiają do
psychiatry i nie są leczone.
Na strone www.twarzedepresji.pl czytamy:
“Statystyki policyjne są wstrząsające. W ubiegłym roku 177 dzieci popełniło
samobójstwo – jedno z nich miało mniej niż 9 lat, 15 ofiar to dzieci w wieku od
10 do 14 lat, a aż 161 – to nastolatki w wieku od 15 do 19 lat. Dwa lata temu
prawie 600 dzieci i młodzieży próbowało odebrać sobie życie. Najgorsze
statystyki dotyczące samobójstw wśród dzieci w powojennej historii Polski skłaniają
do smutnych refleksji. Wiele z tych ofiar cierpiało na depresję. Pomoc nie
przyszła na czas. Z danych cytowanych m.in. przez Rzecznika Praw Dziecka: ponad
9% dzieci i młodzieży zmaga się z zaburzeniami wymagającymi wsparcia
psychiatry, a kryzysem psychicznym dotkniętych jest aż 20% polskich dzieci i
nastolatków. Największy wzrost jest wśród młodych pacjentów z zaburzeniami
depresyjnymi i lękowymi, a także zaburzeniami zachowania i odżywiania.
Wielu rodziców
jest zaskoczonych, że ich brak tolerancji na dziecięcą złość albo na rozdrażnienie
może być przyczynkiem do depresji. Uważają, że złość, krzyk i tupanie to coś
absolutnie niedopuszczalnego i że należy zdusić to w zarodku. Zamiast wpoić
dziecku akceptowalne społecznie sposoby wyrażania złości, frustracji i gniewu,
opiekunowie uczą tłumienia ich. Zabiegani rodzice często nie mają czasu na wsłuchanie
się w problemy dziecka, często też bagatelizują je. Psychika młodego człowieka
jest krucha, codzienne problemy są silnie przeżywane. A świat atakuje z różnych
stron: trudności z nauką w szkole, przemoc psychiczna, konflikty z rówieśnikami,
odrzucenie, konflikty rodzinne, przemoc w szkole czy domu, środowisko
patologiczne i – znak naszych czasów – hejt internetowy. Dzieci muszą mieć możliwość
wyżalić, poradzić, ale i wypłakać się, wykrzyczeć, muszą rozładować skumulowane
emocje. Kiedy są zmuszane do “siedzenia cicho”, wtedy szukają innych sposobów.
Czując, że z dołka, do którego wpadły, nie ma wyjścia, mogą zacząć myśleć: “chcę
zniknąć”, “chcę przestać istnieć”. Niektóre zaczynają eksperymentować z różnymi
substancjami, czy podejmują próby samobójcze.
Depresja należy do grupy zaburzeń nastroju. Mogą
jej towarzyszyć inne zaburzenia psychiczne takie jak np. zaburzenia
depresyjno-lękowe czy adaptacyjne o obrazie tzw. reakcji depresyjnej. Objawami
depresji są m.in: przygnębienie, płaczliwość, apatia, lęk, zniechęcenie,
wycofanie z życia towarzyskiego, zaburzenia łaknienia (nadmierne lub brak łaknienia),
problemy ze snem, depresyjne myśli, niska samoocena, działania autoagresywne,
myśli rezygnacyjne, myśli samobójcze i próby samobójcze. Wiele z nich przybiera
u dzieci inną niż u dorosłych formę. Na przykład smutek i płaczliwość objawia
się zachowaniami odpychającymi, zniechęcającymi do nawiązania kontaktu, łatwo
wpada w złość. Dzieci mogą obwiniać siebie za rozpad rodziny. By “złagodzić” lęki
podejmują nieprzemyślane, impulsywne działania np. eksperymentują z piciem
alkoholu, paleniem, dopalaczami, rozmyślnie zadają sobie ból, zaczynają się ciąć
(samookaleczanie w postaci płytszych i głębszych nacięć na przedramionach czy
udach).
Jak nie przeoczyć symptomów depresji dziecięcej?
Przede wszystkim będąc z dzieckiem, słuchając go, pomagając znaleźć rozwiązania
zaistniałych problemów. U dzieci i młodzieży można zauważyć nieoczywiste objawy
depresji. Należą do nich:
• zaburzenia
koncentracji, kłopoty z zapamiętywaniem, problemy z nauką;
• pobudzenie psychoruchowe (jako wyraz lęku,
odczuwanego napięcia) – wiercenie się, bezwiedne działania typu: skubanie
skórek, obgryzanie paznokci, gryzienie ubrania i ołówków, bezcelowe mazanie czy
pstrykanie długopisem;
• nieadekwatne do sytuacji reakcje –
wybuchanie, wielka drażliwość, reagowanie agresją lub rozpaczą na nawet
najdelikatniejszą uwagę; pesymistyczne podejście do siebie i swoich możliwości;
• dolegliwości somatyczne (bez obrazu w
badaniach) – bóle brzucha, bóle głowy, wymioty, biegunki, omdlenia, duszności,
moczenie nocne;
W okresie dojrzewania (obok burzy hormonów)
zmieniają się także “zadania rozwojowe”, a wraz z nimi nowe wyzwania
psychiczne, z którymi musi sobie poradzić. Przy huśtawce nastrojów, rozdrażnieniach,
lękach, koncentracji na wyglądzie i zmianie autorytetów, mogą pojawiać się:
• bunt – wobec szkoły, rodziców, zasad;
• zachowania agresywne i autoagresywne.
Współwystępowanie depresji z innymi zaburzeniami (lękowymi,
odżywiania, ADHD, spektrum autyzmu, przyjmowanie substancji psychoaktywnych) może
utrudnić diagnostykę. Stąd ważna jest współpraca całego środowiska dziecka.
Obserwacje zachowań w różnych grupach, sytuacja rodzinna (łącznie ze zdrowotną)
– to podstawy na których opiera się diagnostyka i pomoc młodemu człowiekowi.
Leczenie odbywa się zwykle w poradniach zdrowia
psychicznego, czasami na oddziałach dziennych, a w trudnych przypadkach może być
niezbędne umieszczenie młodego człowieka w szpitalu. Metody stosowane w
leczeniu depresji to głównie psychoedukacja i psychoterapia (indywidualna i
grupowa), ale czasami konieczne jest włączenie farmakoterapii. W leczeniu
depresji stosuje się także inne formy terapii np.: muzykoterapię, terapię zajęciową,
aromaterapię, fototerapię.
Decyzję o podjęciu leczenia u dzieci do 16. r.ż.
podejmują rodzice/opiekunowie, po 16. r.ż. nastolatek również musi wyrazić na
nie zgodę.
Leczenie depresji u dzieci i młodzieży wymaga zrozumienia,
wysłuchania i wspierania. Aby było skuteczne, niezbędne jest zaangażowanie
rodziny, nauczycieli i innych osób uczestniczących w wychowywaniu.
Anna Szymańska
Pieniny i okoliczne pasma zna niemal jak własną kieszeń. Fanka fotografii krajobrazowej kilku fotografów Dla zabawy komentuje ich zdjęcia (czasami wierszem). Lubi akcję “zero waste”. Wykorzystuje niektóre “odzyski” w tworzeniu różnych rękodzieł. Miała być nauczycielem w przedszkolu, księgarzem, więc... pracowała w wydawnictwie. Dzieci, wychowanie, ADHD, zespół Aspergera i związana z tym lekcja życia, zaowocowały pisaniem artykułów i wydania książki. Trafiła do Gazety Żoliborza i do pracy w Fundacji Savant.
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