child psychiatry/somatoform disorders Flashcards
childhood disorders
-attention deficit hyperactivity disorder
-autism spectrum disorder
ADHD DSM 5 Criteria
-Inattention: 6+ symptoms of inattention for children up to age 16 years, or 5+ for adolescents >17yo; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
-fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
-trouble holding attention on tasks or play activities.
-doesnt listen when spoken to directly.
-doesnt follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
-organizing tasks and activities.
-avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
-loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
-easily distracted
-forgetful in daily activities.
-Hyperactivity and Impulsivity: 6+ or more symptoms of hyperactivity-impulsivity for children up to age 16 years, or 5+ for adolescents >17 yo; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
-fidgets with or taps hands or feet, or squirms in seat.
-leaves seat in situations when remaining seated is expected.
-runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
-unable to play or take part in leisure activities quietly.
-“on the go” acting as if “driven by a motor”.
-talks excessively.
-blurts out an answer before a question has been completed.
-trouble waiting their turn.
-interrupts or intrudes on others (e.g., butts into conversations or games)
-Cause: Decreased dopamine in the frontal lobe of the brain causes decreased arousal!
ADHD tx: psychostimulants
-(Ritalin, Adderall) 1st Line Tx
-Increase levels of dopamine (and norepinephrine) in the brain
-SE:
-Increased BP, tachycardia, tremor, exacerbation of tics
-Anxiety, insomnia, headache
-Decreased appetite, weight loss, nausea
autism spectrum disorder
-Persistent deficits in social communication and social interaction across multiple contexts, as manifested by following, currently or by hx:
-Deficits in social-emotional reciprocity, ranging, ex. abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
-Deficits in nonverbal communicative behaviors used for social interaction, ranging, ex. from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
-Deficits in developing, maintaining, and understanding relationships, ranging, ex. from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
-Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least 2 of following, currently or by hx:
-Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
-Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
-Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
-Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
autism spectrum disorder severity
-Specifycurrent severity:
-!!Severity based on social communication impairments and restricted, repetitive patterns of behavior.
-For either criterion, severity is described in 3 levels:
-Level 3 – requires very substantial support,
-Level 2 – Requires substantial support, and
-Level 1 – requires support..1
obesity
-BMI > 30
-BMI: measure of adult’s wt in relation to height, specifically adult’s weight in kgs divided by square of height in meters.
-33.8% of US adults and 17% of children 2-19 are obese
obesity prevalence: last 30 years
-Obesity has increased in:
-Both sexes
-All age groups
-All racial/ethnic groups
-However, those at the lowest income levels have increased the most.
-Overweight has replaced malnutrition as the most prevalent nutritional problem for the poor.
conduct disorder
-At least 4 of following have to be present:
-Aggressive behavior toward others and animals.
-Frequent physical altercations with others.
-Use of a weapon to harm others.
-Deliberately physically cruel to other people.
-Deliberately physically cruel to animals.
-Involvement in confrontational economic order crime- e.g., mugging.
-Has perpetrated a forcible sex act on another.
-Property destruction by arson.
-Property destruction by other means.
-Has engaged in non-confrontational economic order crime- e.g., breaking and entering.
-Has engaged in non-confrontational retail theft, e.g., shoplifting.
-Disregarded parent’s curfew prior to age 13.
-Has run away from home at least 2 times.
-Has been truant before age 13!
-The preceding criteria is accompanied by the following:
-1. The behaviors cause significant impairment in functioning and
-Person must be < 18 yo
oppositional defiant disorder
-A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms
-1. Often loses temper.
-2. Is often touchy or easily annoyed.
-3. Is often angry and resentful. Argumentative/Defiant Behavior
-4. Often argues with authority figures or, for children and adolescents, with adults.
-5. Often actively defies or refuses to comply with requests from authority figures or with rules.
-6. Often deliberately annoys others.
-7. Often blames others for his or her mistakes or misbehavior. Vindictiveness
-8. Has been spiteful or vindictive at least 2x within past 6 months, or occupational functioning.
-**Person must be under 18yo.
conduct disorder vs oppositional
-key difference between ODD and conduct disorder lies in role of control
-Kids who are oppositional or defiant will fight against being controlled
-Kids who have conduct disorder will fight not only against being controlled, but will attempt to control others as well.
-This may be reflected by “conning” or manipulating others to do what they want, taking things that don’t belong to them simply because “I want it,” or using aggression or physical intimidation to control a situation.
-Parents of kids who exhibit this type of behavior describe feeling afraid in their own home: “My son actually runs the house. We walk on eggshells.” Living with a child who is oppositional and defiant can leave a parent frustrated, angry, disheartened and sad. It doesn’t typically lead to fear.
treatment options
-Family Interventions—tx involves parents & families of antisocial child.
-Using a behavioral program have taught parents to modify their responses to children so that positive social behavior is rewarded.
-Parents use positive reinforcement (rewards) when the child produces positive behaviors & time-out/loss of privileges for aggressive or antisocial acts.
-Cognitive Problem Solving skills training
-Pharmacological management
somatoform disorders
-CONVERSION DISORDER
-HYPOCHONDRIASIS
-BODY DYSMORPHIC DISORDER
-FACTITIOUS DISORDER
-MALINGERING
somatoform disorders
-1+ somatic symptoms that are distressing or result in significant disruption of daily life:
-Excessive thoughts, feelings, or behaviours related to somatic symptoms or associated health concerns as manifested by at least 1 of following:
-Disproportionate and persistent thoughts about seriousness of symptoms.
-Persistently high level of anxiety about health or symptoms.
-Excessive time and energy devoted to these symptoms or health concerns.
-Although any 1 somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
somatoform disorder: definition
-Unusual physical symptoms in absence of any known physical pathology.
-Psychological conflicts are expressed as physical problems or complaints
-Symptoms usually lead to unnecessary medical tx
somatoform disorders: conversion disorder
-Sudden loss of neurological function (i.e. blindness, paralysis) in the presence of extreme stressor
-“La Belle Indifference”- pt appears less concerned with disability than expected.
