Early onset disorders (2)

Question 1

Elimination of urine or feces inappropriate places (i.e., clothing) whether involuntary or intentional. ____ – passage of feces (either with constipation and overflow incontinence or without constipation).
_______– passage of urine (either nocturnal/nighttime only or diurnal/daytime only).

Answer 1

Encopresis

Enuresis

Question 2

Etiology of enuresis

Answer 2

Both genders can have an elimination disorder. Boys greater than girls, age 4 for encopresis and after age 5 for enuresis.

Question 3

Causes of eneuresis

Answer 3

Causes: Not due to laxatives or diuretics, neurological disease (seizure, spina bifida) or medical condition (infection, diabetes).
*What may happen – parental frustration with subsequent child abuse, humiliation, teasing.

Question 4

Tx for elimination disorders

Answer 4

Treatment: Physical exam – encopresis (laxatives, stool softener, retraining); enuresis (retraining, pad & bell, behavior therapy).
Medication – Impreamine, DDAVP

Question 5

Inhibited, withdrawn, hypervigilant or excessive and inappropriate sociability with strangers; limited eye contact.

Answer 5

Reactive Attachment Disorder

Question 6

Who gets Reactive Attachment disorder

Answer 6

Children up to age 5

Question 7

Causes of Reactive Attachment disorder

Answer 7

Maltreatment, deprivation, repeated changes in primary caregivers, impaired parenting (retardation, depression, substance abuse)

Question 8

Timeline of reactive attachment disorder

Answer 8

May spontaneously remit or may have malnutrition, infection or death; long term behavior changes, short stature, low I.Q.

Question 9

treatement for RAD

Answer 9

Medical care, nutrition, foster, work with parents

Question 10

– losing a lot of weight through dieting and exercising, thinking that one is fat despite the weight loss, being very afraid of gaining weight, girls may stop having their monthly periods.

Answer 10

Anorexia

Question 11

– brief periods during which an enormous amount of food is eaten (bingeing), feeling like one cannot control eating, trying not to gain weight by exercising, dieting, pills or vomiting, a lot of worries about weight.

Answer 11

Bulimia

Question 12

Causes of eating disorders

Answer 12

Different factors may play a role. The brain parts (hypo- thalamus) involved in controlling appetite and hunger may not work well. Other factors may be stress or the belief that it is important to be thin.

Question 13

Associations with eating disorders

Answer 13

n some people, the eating disorder lasts only a few weeks or months. In others, the problem continues for a long time and can be very serious. Death can result from starvation in anorexia. Many people with bulimia suffer from depression.

Question 14

Treatment for eating disorders

Answer 14

Medication (if anorexia is accompanied by depression, anti- depressant medications may be recommended). For bulimia – Tofranil (imipramien), Prozac (fluoxetine)
Psychotherapy – cognitive behavioral therapy, family therapy

Question 15

Quick body movements (tics) that one cannot control; making sounds (like grunts) or saying words (sometimes swear words) without thinking and without being able to control it.

Answer 15

Tourett’s Disorder

Question 16

Who gets Touretts

Answer 16

Most children with this problem are boys, but girls can have it too. Tourette’s disorder usually starts around the age of 7-10. Many times children with Tourette’s disorder have other problems (ADHD or OCD).

Question 17

What are the causes of tourettes

Answer 17

Causes: The exact cause is unknown. Some parts of the brain (basal ganglia) that control movements are not functioning well.

Question 18

Tx options for tourettes

Answer 18

Medications – Haldol (haloperidol), Orap (pimozide), Inversine (mecamylamine HCL)
Psychotherapy – support therapy, family therapy

Question 19

Single or multiple motor or vocal tics (sudden, rapid, recurrent, nonrhythmic, stereotyped motor move- ments or vocalizations).

Answer 19

Tic Disorder

Question 20

Who gets Tic disorder and what causes it?

Answer 20

Children ages 8-10; transient

Not known, not due to Huntington’s chorea, Wilson’s disease, post viral encephalitis or medication (stimulants)

Question 21

Tx for Tic disorder

Answer 21

Psychotherapy, behavior modification, medication

Question 22

Medical Illness in Children and Adolescents: Infancy (0-2)

Answer 22

Change in routine, separation from parents, stranger anxiety, encourage parents to “live in” hospital

Question 23

Medical Illness in Children and Adolescents: Early childhood (2-6)

Answer 23

Separation, aggressive to physicians, regressed bowel/bladder control, fear of minor procedures, fear of bodily harm

Question 24

Medical Illness in Children and Adolescents: School age (6-12)

Answer 24

Behavioral regression, oppositional, irrational explanation of illness

Question 25

Medical Illness in Children and Adolescents: Adolescence

Answer 25

Loss of privacy and autonomy are painful

Question 26

Factors of non-compliance in pts

Answer 26

•Denial or lack of acceptance of the disorder
•Frustration with the outcome or nature of treatment
•Wish to obtain parental attention or special privileges via
symptoms
•Wish to regain control
•Rebellion against parents
•Lack of knowledge or skills •Inability to resist peer pressure
•Lack of relationship or miscommunication with health care time
•Psychotherapy

Question 27

Family factors in medical illness

Answer 27

Unresolved guilt, denial, anger and/or fear
Lack of knowledge and skills
Inability to encourage adolescent independence
Competition with medical personnel Lack of support system
Other stressors on family
Family conflicts acted out through the child’s medical care
Rivalry between patient and health sibings

Question 28

Treatment Related Factors in medical illness

Answer 28

Interference with usual activities
Side effects of drugs (pain, nausea, weight gain, hair loss)
Clarity of connection between noncompliance and sequelae
Disinterested, inconsistent medical personnel

Question 29

Emotional and Behavioral Reactions Should be Anticipated when children have medical illness

Answer 29

Explain in advance as much as the child’s age, coping style, and medical situation allow
Minimize separations from parents, especially for children under 8 yo
Try to understand the meaning of the illness to the child and correct her/his misconceptions
Understand that the child/adolescent needs to control something in the environment and arrange the milieu so that this will not interfere with treatment
Do not criticize or blame the child or parents for regressive behavior

Question 30

Indications for Consultation with Child/Adolescent Psychiatrist after the Initial Screening Assessment

Answer 30

•Physical symptoms with unexplained etiology or severity •Noncompliance with medical treatment
•Developmental delays
•Physician observation of child or parents’ report of depression,
anxiety or hyperactive behavior •Impaired school performance
•Problems with peer or family relationships •Suspected substance abuse
•Parental difficulties with child rearing