Childhood and Adolescent Psychiatric disorders Flashcards
List 6 common childhood/adolescence common mental disorders
Common Disorders
• Autism Spectrum disorder • ADHD
• Intellectual disability
• Tic disorders
• Anxiety disorders
• Elimination disorders
____________ Disorders – is by far the best known neurodevelopmental disorder.
Autism Spectrum
Autism Spectrum Disorders –
• Marked and Sustained impairment in ________________________ with restricted or stereotyped patterns of __________________________________.
• Abnormalities in functioning in each of these areas must be present in the early neurodevelopmental period ( by age ______ years).
social interaction and communication
behavior and interest
3
Autism spectrum disorders
• Often a spectrum in presentation – high or low functioning IQ levels.
•__________________ is the most common comorbid diagnosis.
Intellectual disability
Autism: Epidemiology
• Difficult to compare across continents
• Most begin before ___ years
• Boys: Girls = ________
• (Male or Female?) protective, more severely whn affected (?More mutations and environmental toxin load)
3
3-5: 1
Female
Autism
Often misdiagnosed as ________,_______, or ________
ADHD, OCD, ID
ASD DSM 5 CRITERIA
• Core symptom domain
• A. ____________ deficits in ____________________ across multiple contexts (SCI)
•B. __________,__________ patterns of ________,___________, or activities. (RRBI)
•C. must be present in the ________ developmental period (manifest until social demands exceed limited capacities, or masked by learned strategies in later life).
•D. cause clinically significant impairment in social, occupational, or other important areas of current functioning.
•E. not better explained by id or global developmental delay. ID &ASD frequently co-o
Persistent; social communication and social interaction
Restricted, repetitive ; behavior, interests
early
Persistent deficits in social communication and social interaction across multiple contexts
• Deficits in __________________
• Deficits in __________________
• Deficits in ___________________________
• Specify current severity
social-emotional reciprocity
nonverbal communicative
developing, maintaining, and understand relationships
Autism-Differential Diagnosis (what else could it be)
• __________ impairment
• _______________
• Severe Psychosocial deprivation
• ____________ & ______________ disorder
• Specific language disorder
• Childhood ______________
•_________,_________
Sensory
Intellectual disability
Selective mutism & separation anxiety
schizophrenia
OCD, ADHD
• __________________ Disorder (ADHD) – (aka ______________ disorders).
Attention Deficit Hyperactivity Disorder (ADHD)
hyperkinetic
____________________ is the most common psychiatric disorder among school-age children and the best understood.
Attention Deficit Hyperactivity Disorder (ADHD)
Children with ADHD display the early onset of symptoms consisting of developmentally inappropriate __________,__________ , academic ____________, and ___________ behavior.
overactivity ; inattention
underachievement
impulsive
• In making a diagnosis of hyperkinetic disorder requires the definite presence of abnormal levels of underachievement, hyperactivity, and restlessness that are pervasive across situations and persistent over time and that are not caused by other disorders such as autism or affective disorders for at least ___________.
6 months
ADHD Risk and aeitiology.
•_______,__________ , and molecular genetic studies show ADHD to be highly __________, and other findings have recorded ____________ and psychosocial adversity as risk factors.
Twin, adoption
heritable; obstetric complications
ADHD risk and Aetiology
• Evidence from animal and human studies implicates the dysregulation of ________________________ catecholaminergic circuits in the pathophysiology of ADHD, and molecular imaging studies suggest that abnormalities of the ____________________ lead to impaired neurotransmission
frontal-subcorticalcerebellar
dopamine transporter
ADHD Epid and Diagnosis
Common in (men or women?)
Common in (lower or upper?) economic strata
Men
Lower
ADHD Treatment
• Studies during the past decade have shown the safety and effectiveness of new non-stimulant drugs (_______________ ) and long-acting formulations of ——————— .
•____________ and ____________ techniques will be useful for children below age ____ years.
Atomoxetine
methylphenidate and amphetamine
Parental training and behavioral management
6
Definition of ID
•A disability characterized by significant limitations both in _____________ and in ______________.
• It covers many everyday social and practical skills.
intellectual functioning
adaptive behaviour
ID
If the disability originates before the age of 18 it is named ________________________
intellectual developmental disorder
Intellectual Disability
Intellectual Functioning:
Refers to ______________________ , such as learning, reasoning, problem solving.
One criterion to measure intellectual functioning is an _________ test.
general mental capacity
IQ
ID
Generally, an IQ test score of below _____ (____ standard deviations) indicates a limitation in intellectual functioning.
70
2
ID
Degrees of Severity
Mild Mental Retardation (__________): _______
Moderate Retardation (__________) : _______
Severe Mental Retardation : _______
Profound Mental retardation : _______
educable; IQ 50/55 – 70
trainable IQ 35/40 – 50/55
IQ 20/25 – 35/40
IQ below 20/25
Signs of ID in Children?
More likely globally ________ across all skill areas
delayed
An intellectual disability is a disease.
T/F
F
Not
ID is a mental illness.
T/F
F
Not
___________ is the cure for intellectual disabilities.
There is no cure for intellectual disabilities.
Tic Disorders
These comprise a group of _____________ disorders that appear in childhood or adolescence, encompass a wide range of severity, and share the primary symptom of __________ and ____________.
neuropsychiatric
persistent and interfering tics
The most widely recognized and severest form of tic disorder is _____________ or _______________
Gilles de la Tourette syndrome, or Tourette’s disorder.
Tics
• Tic - Sudden, rapid, recurrent, nonrhythmic motor movement or vocalization.
• They may be classified according to
___________(_____,_______)
___________(_____,_______)
___________(_____,_______)
- degree of complexity (simple, complex) - their quality (motor, vocal)
- Duration (Transient, Chronic)
obscene gestures , referred to as _____________
compelled to repeat or imitate a movement observed in another person (_______________).
___________ is the utterance of obscene or aggressive words or sentences
copropraxia
echopraxia
Coprolalia
Characteristics of Attachment
Bowlby believed that there are four distinguishing
characteristics of attachment:
- Proximity Maintenance - The desire to _____________________________.
- Safe Haven - Returning to the attachment figure for ___________________________.
- Secure Base - The attachment figure acts as a ________________.
- Separation Distress - Anxiety that occurs in the ___________________
be near the people we are attached to
comfort and safety in the face of a fear or threat
base of security from which the child can explore the surrounding environment.
absence of the attachment figure
Two subtypes of attachment disorders
List them
RAD – Reactive Attachment disorder
DSED – Disinhibited social engagement disorder (DSM 5)
Two subtypes of attachment disorders
RAD – Reactive Attachment disorder: linked to ________________________, is characterized by inhibition of the normal developmental tendency to _______________________.
early childhood maltreatment
seek comfort from caregivers
Subtype of attachment disorders
DSED – Disinhibited social engagement disorder (DSM 5) : linked to ________________________________, is characterized by a relative ______________ of the attachment system, resulting in “ ________ “ and ___________ attachments, and patterned behavior labeled “indiscriminate sociability.“
institutionalization or exposure to multiple caregivers before age 5
hyper activation
diffuse; unselective
Elimination disorders:Enuresis & Encopresis
Enuresis is - defined as the involuntary or intentional ____________.
Diagnosis is made only after age ______ years. Severity is determined by ___________ of urination; __________ is not a diagnostic consideration per se.
It must occur at least __________ for at least ________________________ , or if less frequent, it must produce significant distress or functional impairment.
__________ causes such as a bladder infection must be excluded.
There is a correlation between enuresis and psychological disturbance that increases with age
voiding of urine
5; frequency
quantity; twice a week ; 3 consecutive months
Physical
Oppositional Defiant Disorder (ODD)
• ODD is a relatively common childhood disorder with an estimated
prevalence of 2% to 10%
• Prevalence estimates may, however, vary depending on factors such as _________________ (e.g., parent vs. child), _______________ (e.g., concurrent vs. retrospective) and whether or not children meeting criteria for conduct disorder are included.
informant source
type of report
ODD is significantly more common in (boys or girls?) than (boys or girls?).
• Symptoms are relatively stable between the ages of ______ and ______, but are thought to decline after that point.
Boys; girls
five and ten
ODD is diagnosed more rarely in older children, partly in order to avoid ??????????.
labelling normative discord between children and their parents during adolescence
In ICD-10, ODD is thought to only be a milder form of ______________.
conduct disorder
Conduct Disorders
• ICD-10 has a category for conduct disorders, ____.
The clinical descriptions and diagnostic guidelines state: “Examples of the behaviours on which the diagnosis is based include the following:
• excessive levels of __________________;
• cruelty to __________ or __________;
•severe destructiveness to
• property; firesetting; stealing; repeated lying; truancy from school
• and running away from home; unusually frequent and severe
• temper tantrums; defiant provocative behaviour; and persistent
• severe disobedience. Any one of these categories, if marked, is
• sufficient for the diagnosis, but isolated dissocial acts are not.”
F91
fighting or bullying
animals or other people
Symptoms of Conduct Disorder
To make a diagnosis, _____ symptoms have to be present, one for at least __________.
•_____ behaviours are listed to consider for the diagnosis of conduct disorder.
3; 6 months
15
Conduct disorder
15 behaviours are listed to consider for the diagnosis of conduct disorder. They can be grouped into four classes:
List them
Aggression to people and animals
• Destruction of property
• Deceitfulness or theft
•Serious violatons of rules
Conduct disorder
There are three subtypes:
•conduct disorder confined to _________________ (F91.0),
•___________ conduct disorder (F91.1, where the young person has no friends and is rejected by peers),
•and ___________ conduct disorder (F91.2, where peer relationships are normal).
the family context
unsocialised
socialised
Depression
• To be diagnosed with MDD, a child or adolescent must have at least _________ of _____________________ manifested by either ________ or ________ mood and/or _________________ plus a group of other symptoms including wishing to be dead, suicidal ideation or attempts; increased or decreased appetite, weight, or sleep; and decreased activity, concentration, energy, or self-worth or exaggerated guilt
2 weeks
persistent change in mood
depressed or irritable
loss of interest and pleasure
Overall, the clinical picture of MDD in children and adolescents is similar to the clinical picture in adults, but there are some differences that can be attributed to the childs physical, emotional, cognitive, and social developmental stages
For example, children may have mood lability, irritability, low frustration tolerance, temper tantrums, somatic complaints, and/or social withdrawal instead of __________ feelings of depression.
Also, children tend to have fewer ____________ symptoms, _________, and _____________ than depressed adults.
verbalizing; melancholic
delusions
suicide attempts
Anxiety disorders
• Extremely (common or rare ?) in children and adolescents.
• 1.5-2 times as many (males or females?) compared to (males or females?) for most anxiety disorders.
• _______ childhood to _________ as onset
Common
Females; males
Middle; adolescence
Anxiety disorders: Developmental Response
• Infants - fear of ________
• Toddlers – fear of ______, __________
• School age – injury , natural events like storms
• Older children /adolescents – worries and fears relating to ________________.
• There are normative but problematic if they do not subside over time or impair functioning.
loud noises
strangers; imaginary creatures.
school performance
Anxiety disorders: developmental response
• Animal phobias –______ childhood (around 6-7 years)
• Separation anxiety disorder – _____________ childhood (around 7-8
years)
• Generalised anxiety disorder – _____ childhood (around 10-12 years)
• Social anxiety disorder –_____________ (around 11-13 years)
• Obsessive compulsive disorder –______________ (around 13-15
years)
• Panic disorder –______________ (around 22-24 years)
early
early to mid-
late; early adolescence
mid adolescence
early adulthood
Separation anxiety disorder
Core features
Fear or concern that something bad wil happen to the child or attachment figure (commonly a parent) when they are separated.
As a result of this belief, the child avoids separation from the attachment figure.
Generalised anxiety disorder
Core features?
Atendency to worry about a wide range of negative possibilities, that something bad wil happen
Social phobia
Core features?
Fear and avoidance of social interactions or social performance due to a belief that others wil negatively evaluate the child
Panic disorder
Core features?
Experience and fear of unexpected panic attacks commonly involving several somatic symptoms and fears of dying or going crazy
Agoraphobia
Core features?
Fear of agoraphobic situations commonly due to fear of experiencing a panic attack in those situations
Elimination Disorders
• Elimination disorders occur when children who are otherwise old enough to _________________ appropriately repeatedly __________________ in inappropriate places or at inappropriate times.
• The two disorders under this category are __________ and ___________.
eliminate waste
void faeces or urine
Enuresis and Encopresis
Enuresis
•PRIMARY if child ___________________________
•SECONDARY enuresis refers to bedwetting episodes that occur after a child _________________________
has never been dry at night or only is occasionally dry at night.
has been dry at night for a considerable length of time
Treatment
The treatment of enuresis can take a multiple approach;
•1.____________ and _________
2. ______________therapy
3. _____________ & Other
Counseling and Psychotherapy
Pharmaco
Behavioral
Treatment
The treatment of enuresis can take a multiple approach;
Pharmacotherapy : In older children, imipramine may be prescribed, but close observation of the child’s response to medication must be maintained. Imipramine may begin to work by the ____________ night. Treatment usually lasts ____________
______ relapse rate.
first or second
4 to 6 months.
High
Treatment of enuresis
Behavioral & Other:
_________________ Pants
Ensure ________ to the toilet at night
Encourage a ____________ throughout the day
Encourage small steps, such as going to the toilet before bed without prompting
Enuresis ________ or ________
Night-time Protection
easy access
good level of fluid intake
alarm or buzzer
Imipramine (Tofranil) - a _________________.
Desmopressin acetate - a ________ form of the _______________ and is administered as a ___________.
tricyclic antidepressant
synthetic; antidiuretic hormone
nasal spray
Which is less common?
Enuresis or Encopresis?
Encopresis
Adolescence
•Adolescence is the period in of transition from ________ to _________
childhood to adulthood.
In adolescence,
Brain development is a mix of ________ and _____________. In the Adolescent Brain the ____________ and ____________ is thought to ensure that appropriate connectivity is established, with neurons and synapses that fail to make appropriate connections being lost
expansion and regression
overproduction and pruning
Adolescent Psych disorders
• _______
• ____________ DISORDERS
• ____________ DISORDERS (Depression and Bipolar disorders)
• DELIBERATE ____________
• ____________ ____________
• PUI
• ____________ DISORDERS
• ____________
Adolescent Psych disorders
• ADHD
• ANXIETY DISORDERS
• MOOD DISORDERS (Depression and Bipolar disorders) • DELIBERATE SELF HARM
• SUBSTANCE ABUSE
• PUI
• EATING DISORDERS
• PTSD
_____________ is one of the most common forms of emotional problems in young people.
A mood disorder.
Depression
Experts estimate that about one in __________ teens are depressed (Reynolds, 1995).
twenty
One in _________ depressed adolescents use drugs or alcohol to cope with the problem (Fleming and Offord, 1990).
four
Bipolar disorder
• Common mood disorder with onset in ________ or ____________.
• Characterised by fluctuation in mood.______ versus _____ mood.
•___________, increased _______[, decreased need for _______. High risk behaviour
• Often a positive ________ history exists.
• In adolescence – substance abuse, irritability/ aggression, indiscriminate sexual behaviour.
adolescence or young adding
High: Low
Grandiosity; energy; sleep
family
Obsessesive Compulsive disorder (OCD)
•Similar to adults with OCD, 60% to 80% of affected children and adolescents have ______________________.
•Some of the most common are _____ disorders, _______________, other anxiety disorders, mood and eating disorders.
one or more comorbid psychiatric disorders
tic; attention deficit hyperactivity disorder (ADHD)
OCD
Two components ;
•Obsession –________ component – ________,__________.
•Compulsion – to _________ the obsession
thought; intrusive ; ego dystonic
relieve
______________________________ ((PIU)
PROBLEMATIC INTERNET USE
Commonest type of eating disorder is??
Anorexia nervosa
Anorexia nervosa.
Characterized by
____________+ ___________ + ___________
Weight preoccupation
retricted diet
Weight loss
BN- Bulimia Nervosa
Characterized by
_________________ +_________ + ___________
Weight preoccupation
overeating
purging
ARID – ????
Avoidant and restrictive intake disorder.
PTSD
Characterised by triad of ___________,___________, and _____________
Diagnosed at least ________ after event
intrusive thoughts (flash backs), hyperarousal, and avoidance.
a month
