Early Onset Disorders Flashcards
What is Mental Illness:
Substantial disorder of:
- Thought, mood, perception, or memory
- Which grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life
- Does not include substance abuse
List of Mental Disorder
A. Mood disorders: Depression and mania B. Psychotic disorders: Schizophrenia C. Anxiety disorders D. Adjustment disorders E. Substance use disorders F. Personality disorders G. Behavior or mood problems caused by other neurological or medical illness
Differences between adult and child/adolescent psychopathology
1.) The child is developing and changing; therefore,
pathology at one age is not pathology at another age (i.e., temper tantrums)
2.) With the adult the norm is relatively static; therefore, one must know:
The capacity for impulse control, ego, and superego
The state of interpersonal relationship
The level of drive development
Certain disorders occur at certain stages of development; for example,
one cannot see obsessive-compulsive neurosis prior to age four or five.
How are adults and children different when suffering and anxious
Children do not seek help though they may become anxious. Suffering, however, will prompt adults to seek care. The child will more often come for treatment because of discomfort on the part of the parent or community, such as the school
Stress: Autonomic Nervous System
Generic Signs and Symptoms of Stress
- Eating
- Sleep
- Activity level
- Regression
stranger anxiety
•Fear – sudden stimulation
Infant –
temper tantrums, soiling/wetting, stuttering
•Fear – animals
Toddler (1-2 1⁄2) –
intrusiveness, masturbation
•Fear – monsters, mutilation, phobias
Preschool (2 1⁄2 - 5) –
truancy, lying, stealing, learning problems
•Fear – Burglars, obsessions
School age (5 – pubescence) –
identity crisis, sexual acting out, substance abuse, delinquency
•Fear – war; death
•Adolescence –
Intellectual – Mental Retardation
Symptoms:
**3% of school age children, more common in boys than girls.
Significant sub-average on general intellectual functioning, with concurrent deficits in adaptive behavior and with onset before age 18.
Causes of Mental Retardation
Causes: Lack of stimulation, inadequate nutrition, exposure to toxins such as lead; 25% due to chromosomal abnormality (such as Down’s syndrome or fragile X) or metabolic abnormality (such as phenylketonuria); pregnancy trauma (drugs, radiation, toxemia, alcohol, infection such as German measles); infections such as encephalitis.
Developmental: Pervasive Development Disorders
Symptoms:
Distortions in timing, rate, sequence of many basic psycho- logical functions involved in the development of social skills and language.
Two types of developmental: Pervasive devo disorders
Autism
Aspergers
Signs and symptoms of Autism
Impaired nonverbal behaviors such as eye contact and gestures Failure to develop age appropriate peer relations
Lack of social reciprocity
Delay or lack of spoken language
Lack of make-believe play
Restricted stereotyped patterns of behavior
Causes: Genetics, infections
Signs and symptoms of Aspergers
Impaired social interaction
Restricted, stereotyped patterns of behavior
Treatment: Parental support, special programs
Specific Developmental Disorders (Learning Disorders) symptoms
Delay in rate of learning a specific function so that children behave as though they are passing through an earlier normal developmental stage substantially below expected for chronologic age; may be one or more in areas of arithmetic, expressive writing, reading, articulation, expressive language, receptive language, coordination.
who has Learning disorders and what is the treatment?
10% of children, more common in boys than in girls
Treatment: Remedial work
Unclassified Speech Disfluencies Symptoms: Who can have stuttering: Cause: Treatment:
Stuttering – sound and syllable repetition
3- and 4-year-olds
Developmental
Ignore; 1% persist and require speech therapy
Pattern of negativistic, hostile and defiant behavior lasting at least 6 months with the following signs – often loses temper, often argues with adults, defied or refuses to comply, deliberately annoys, blames others, resentful, spiteful, and vindictive.
Behavioral: Oppositional Defiant Disorder
Who can have oppositional defiant disorder:
Children and adolescents; boys more than girls
Causes and tx of Oppositional Defiant Disorder
Cause: Environmental (parents over-assert control)
Treatment: Parent training program, psychotherapy, social skills training, cognitive behavior therapy
Fidgety or restless, unable to sit still for a long time, always on the go, easily distracted, cannot concentrate well on work, impulsively acting before thinking, forgetting what was said or not listening, difficulty finishing work on time, often losing personal things, difficulty waiting in lines or jumping ahead of others.
Attention Deficit Disorder
How common is ADD:
About 5% of children have ADD. Many times children have other learning problems as well. Often start having problems in kinder- garten or first grade, and problems may continue for years.
Causes of ADD:
Children are born with ADD and cannot control the symptoms easily. ADD often runs in families (hereditary). It is not caused by allergies or too much sugar
Medical treatment for ADD
– Ritalin (methylphenidate); Metadate, Concerta
– Dexedrine (dextroamphetamine); Adderall
– Cylert (pernoline)
– Pamelor (nortriptyline)
– Norpramin (desipramine)
– Catapres (clonidine)
– Strattera
Non-medical tx for ADD
Psychotherapies: Behavioral therapy, parent management training, family therapy
Educational: Special education classes
What are some concerns for untx ADD
Untreated, ADD can lead to difficulty with learning, with classroom behavior, with making friends, and following rules at home. Many children do not
outgrow ADD completely when they get older and will benefit from taking medication for a long time.
Frequent lying, stealing, truancy, running away from home, frequent fighting/bullying, property destruction, fire-setting, being mean to animals or people, breaking and entering into someone’s house or car.
Conduct Disorder:
Who can have Conduct Disorder:
Older children and teenagers, it is more common in boys. Most children with CD also have other problems. Some of them have ADD, others have depression or alcohol abuse, and still others have many family problems.
Causes of conduct disorder
Causes: The exact cause is not known. Many factors, such as drugs, family problems, low self-esteem, physical abuse, and impulsivity may contribute to behavioral problems.
risk associated with conduct disorder
Teenagers are at risk for dropping out of school, being seriously injured in flights, or getting hooked on street drugs. Teenagers may get into trouble with the police. Without treatment, many of these children/teenagers continue to have similar problems as adults and may become imprisoned.
Treatment options for conduct diosrder
Medication – meds for depression, Lithium for aggressive and impulsive behavior
Psychotherapy – behavioral therapy, group therapy, family therapy
Special Programs – probation programs, residential programs
constant worrying, unable to relax, aches and pains (mostly headaches and stomachaches), self-consciousness, nightmares about the same things that cause worry
GAD
unable to leave parents because of worries that something bad may happen to them; fear of going to sleep, reluctant to go to school, fear of being kidnapped
SAD
Etiology of SAD and GAD
both children and teenagers can have these two different disorders. Separation anxiety usually starts in younger children (~7 to 10 years old). GAD usually first appears in teenagers (12 to 15 years old)
Causes of anxiety disorder
Causes: The exact cause is not known. A tendency to develop severe anxiety runs in some families (hereditary). Stress can play a role (i.e., a death, a parents’ illness, another medical problem, or learning problems).
Tx options for anxiety disorder
Medications – Tofranil (imipramine), Xanax (alprazolam), BuSpar (buspirone), Paxil (paroxetine), Zoloft (sertraline)
Psychotherapy – behavioral therapy, cognitive behavioral therapy, family therapy
Obsessions are thoughts or images, like memories or pictures, that keep coming into one’s mind even though the person wants the thoughts to stop. Compulsions are actions and behaviors that one feels need to be done over and over again, and one cannot stop doing them. A lot of worries and anxiety occur if one tries to stop the obsessions or compulsions.
Obsessive Compulsive Disorder
Who can have OCD:
Both children and teenagers. As much as 1% of children/teenagers may have OCD.
Causes of OCD:
Exact cause unknown. Some parts in the brain do not seem to work well in OCT (basal ganglia) post strep infection.
Treatment options for OCD
Medication – Anafranil (clomipramine), Prozac (fluoxetine), Zoloft (sertraline), Luvox (fluvoxamine)
Psychotherapy – behavioral therapy, cogntiive behavioral therapy
Periods of extreme anxiety or fear that begin suddenly, lasting minutes to hours with shortness of breath, feeling dizzy or faint, racing heartbeat, feeling shaky, stomach upset, sweating, thinking one may lose control – often there is also a big fear of getting another period of anxiety.
Panic Disorder
Who does Panic disorder generally present in?
PD is rare in young children, but becomes more frequent in teenagers. As with many medical problems, the tendency to have PD runs in some families (hereditary).
Causes of Panic disorder
In a very frightening situation, the symptoms of panic attack (extreme anxiety or fear) would be normal and expected. However, in people with PD, the part of the brain that controls anxiety (locus ceruleus) reacts for no apparent reason, giving the person extreme anxiety even though he/she is not in a frightening situation.
Tx options for Panic Disorder
Treatment: Medication – Tofranil (imipramine), Xanax (alprazolam), Paxil (paroretine).
Psychotherapy – Cognitive behavioral therapy
Nightmares or flashbacks (re-experiencing the trauma in one’s mind, along with a sudden feeling of fear that the trauma is happening again), avoid situations that bring the trauma back into memory, difficulty remembering the trauma, losing interest in things, hopelessness (the future doesn’t look good), constant fear about not being safe, severe anxiety and depression
PTSD
Who do we see PTDS in?
People with PTSD have had a very bad experience (physically or sexually abused, natural disasters, seriously injured) which leads to intense and continuing feelings of threat and helplessness. PTSD may also be seen in children who have witnessed a serious accident or saw someone get badly injured. Anyone, of any age, who has lived through a traumatic event might show PTSD symptoms.
causes for PTSD
Causes: The trauma that caused PTSD is so intensely frightening that the fears and memories are present for a long time. It is almost as if some parts of the brain, such as the parts involved in remembering things, become over- charged and stay too active. It is not clear why some people who experience trauma get PTSD or why others don’t.
Tx options for PTDS
Treatment: Treatments used for depression or anxiety may be useful (see sections on depressive disorders and generalized anxiety disorder).
Depressed (feeling sad), losing interest in things, sleep problems (difficulty staying or falling asleep, or sleeping too much), changes in appetite or weight, feeling tired, difficulty concentrating, feeling slowed down, feeling worthless (like you are a bad person), feeling that life is not worth living, hopelessness.
Depressive Disorders
Who do we see depressive disorder in?
People of all ages can have depression. It is more common in teenagers than in children. Up to 5% of teenagers may have depression in their teenage years.
Causes of Depressive Disorder
Causes: Some types appear to be inherited. Certain people under a lot of stress can develop depression. Stress can include losing someone important, school problems, frequent arguments with family, having been abused, or another medical problem. At other times, the part of the brain that keeps the mood happy (brain chemicals – serotonin and norepinephrine) doesn’t function well.
What happens when depression is left untreated?
When not treated, depression in children and teenagers might last for months or years. A person who has had one episode of depression might develop another at a later time. Teenagers who have serious depressions may be at risk of developing other psychiatric problems in the future, such as substance abuse or suicide attempts.
Treatment for Depressionq
Antidepressant medications – Tricyclics; Norpramin (desipramine) and Pamelor (nortriptyline) – SSRI’s; Prozac (fluxetine), Celexa (citalopram), Zoloft (sertraline), Luvox (fluvoxamine), Paxil (paroxetine) – MAOI’s; Nardil (phenelzine), Parnate (tranylcypromine)
Psychotherapy – cognitive therapy, interpersonal therapy, family therapyc
show depressive symptoms at some times and manic symptoms at other times. For depression symptoms see Depressive Disorders. For mania, the symptoms are an abnormally “high” mood (euphoria or feeling too good), extreme irritability, impulsive behavior, abnormally high self- esteem, racing thoughts and talking much more than usual, decreased need for sleep, high energy level, inability to concentrate well.
Bipolar Disorder
Who do we see bipolar disorder in?
relatively uncommon in young children, but it becomes more common in older teenagers. The tendency to develop mania runs in some families. Overall, it is much less frequent than depression.
Cause of bipolar disorder
BP is believed to be due to a chemical imbalance, meaning that the part of the brain that keeps the mood stable isn’t working well.
Timeline of bipolar disorder
Most people with BP go through cycles of depression, mania, and normal mood. Many times, it is a lifelong problem, but it can often respond well to medication. During periods of depression, substance abuse, suicide attempts, or anxiety may be seen. During periods of mania, there may be violence, making bad decisions, or exhaustion.
Tx options for bipolar
Medications – Eskalith CR (lithium), Tegretol (carbamazepine), anti-psychotic medication such as Trilafon (perphenazine), Depakene or Depakote (valproate), Klonopin (clonazepam), Lamictal (lamotrogine), Zyprexa (olanzapine).
Psychotherapy – supportive therapy, cognitive treatment for depression, family therapy
____ – hearing or seeing things that are not there, as if your mind is playing tricks on you.
_______ – beliefs that are impossible or unrealistic, which other people do not believe, and being convinced that these beliefs are really true.
Hallucinations
Delusions
Hallucinations and Delusions, Difficulty organizing thoughts and actions so that other people may have a hard time understanding what you are saying or doing.
Psychosis
Who can have psychosis?
Children and adolescents can have psychosis. Psychosis is not a disorder, but it is a symptom that can happen in many disorders.
What disorders can we see psychosis in?
Some disorders, such as depression or bipolar disorder, can happen with or without psychosis. Schizophrenia always has psychosis as a symptom. Intoxication with street drugs can produce a temporary psychosis.
Cause of psychosis
Some brain parts may be too active in psychosis. The chemical called dopamine (a neurotransmitter) may be overproduced in the brain of people with psychotic symptoms.
Timeline of pyschosis
Psychosis can be very brief (hours or days) or very long (years). It can happen only once or can come back many times. Some people require hospitalization.
Tx options for pyschosis
Medication – Trilafon (perphenazine), Haldol (haloperidol), Mellaril (thioridazine), Thorazine (chlorpromazine), Risperdol (resperidone).
Psychotherapy – supportive therapy, family therapy
