Early onset disorders (2) Flashcards
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).
Encopresis
Enuresis
Etiology of enuresis
Both genders can have an elimination disorder. Boys greater than girls, age 4 for encopresis and after age 5 for enuresis.
Causes of eneuresis
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.
Tx for elimination disorders
Treatment: Physical exam – encopresis (laxatives, stool softener, retraining); enuresis (retraining, pad & bell, behavior therapy).
Medication – Impreamine, DDAVP
Inhibited, withdrawn, hypervigilant or excessive and inappropriate sociability with strangers; limited eye contact.
Reactive Attachment Disorder
Who gets Reactive Attachment disorder
Children up to age 5
Causes of Reactive Attachment disorder
Maltreatment, deprivation, repeated changes in primary caregivers, impaired parenting (retardation, depression, substance abuse)
Timeline of reactive attachment disorder
May spontaneously remit or may have malnutrition, infection or death; long term behavior changes, short stature, low I.Q.
treatement for RAD
Medical care, nutrition, foster, work with parents
– 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.
Anorexia
– 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.
Bulimia
Causes of eating disorders
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.
Associations with eating disorders
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.
Treatment for eating disorders
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
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.
Tourett’s Disorder
Who gets Touretts
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).
What are the causes of tourettes
Causes: The exact cause is unknown. Some parts of the brain (basal ganglia) that control movements are not functioning well.
Tx options for tourettes
Medications – Haldol (haloperidol), Orap (pimozide), Inversine (mecamylamine HCL)
Psychotherapy – support therapy, family therapy
Single or multiple motor or vocal tics (sudden, rapid, recurrent, nonrhythmic, stereotyped motor move- ments or vocalizations).
Tic Disorder
Who gets Tic disorder and what causes it?
Children ages 8-10; transient
Not known, not due to Huntington’s chorea, Wilson’s disease, post viral encephalitis or medication (stimulants)
Tx for Tic disorder
Psychotherapy, behavior modification, medication
Medical Illness in Children and Adolescents: Infancy (0-2)
Change in routine, separation from parents, stranger anxiety, encourage parents to “live in” hospital
Medical Illness in Children and Adolescents: Early childhood (2-6)
Separation, aggressive to physicians, regressed bowel/bladder control, fear of minor procedures, fear of bodily harm
Medical Illness in Children and Adolescents: School age (6-12)
Behavioral regression, oppositional, irrational explanation of illness
Medical Illness in Children and Adolescents: Adolescence
Loss of privacy and autonomy are painful
Factors of non-compliance in pts
•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
Family factors in medical illness
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
Treatment Related Factors in medical illness
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
Emotional and Behavioral Reactions Should be Anticipated when children have medical illness
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
Indications for Consultation with Child/Adolescent Psychiatrist after the Initial Screening Assessment
•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