Early Onset Disorders Part 2

Question 1

What is the definition of a mental illness?

Answer 1

• Mental illness is a 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

Question 2

What are some examples of mental illness? (7)

Answer 2

• Mood disorders: depression & mania
• Psychotic disorders: Schizophrenia
• Anxiety disorders
• Adjustment disorders
• Substance use disorders
• Personality disorders
• Behavior or mood problems caused by other neurological or medical illness

Question 3

Most **problems of childhood & adolescence **represent a _____ resulting from a strain on the child’s ______ ______ as the child grapples w/ a developmental task.

Answer 3

crisis

coping ability

Question 4

With regards to problems of childhood & adolescence, it is important to distinguish between what is merely a ______ and a ______.

Answer 4

stress

strain

Question 5

What is the main difference between psychopathology in children vs. adults?

Answer 5

• Child
  
  • Developing & changing
  • Pathology at one age is not pathology at another age
• Adult
  
  • Norm is relatively static
  • One must know:
    
    • The capacity for impulse control, ego & superego
    • The state of interpersonal relationship
    • The level of drive development

Question 6

Certain disorders occur at certain stages of development

You can’t see obsessive-compulsive neurosis prior to age ______.

Answer 6

5

Question 7

Who will preferentially seek care? Children or adults?

Answer 7

• Children do not seek help though they may become anxious
  
  • Will more often come for treatment b/c of discomfort on the part of the parent or community (school)
• Suffering will prompt adults to **seek care **

Question 8

**Assessment Schema of Anxiety **

• Solutions
• Questions
• Communication

Answer 8

• Solutions
  
  • Normal – developmental conflict
  • Reactive – developmental interference
  • Neurotic
  • Psychotic
  • Psychphysiologic
  • Characterologic
• Questions
  
  • What is it?
  • How long has it been going on?
  • How many areas of life space are affected?
  • Prior problems
• Communication
  
  • Act up
  • Test limits
  • Experiment
  • Act out

Question 9

What are the 4 general signs & symptoms of stress?

Answer 9

• Eating
• Sleep
• Activity level
• Regression

Question 10

What are the age specific signs/symptoms of stress?

• Infant
• Toddler (1 - 2.5)
• Pre-school (2.5 - 5)
• School age (5 - pubescence)
• Adolescence

Answer 10

• Infant
  
  • Stress: stranger anxiety
  • Fear: sudden stimulation
• Toddler (1 - 2.5)
  
  • Stress: temper tantrums, soiling/wetting, stuttering
  • Fear: animals
• Pre-school (2.5 - 5)
  
  • Stress: intrusiveness, masturbation
  • Fear: monsters, mutilation, phobias
• **School age (5 - pubescence) **
  
  • Stress: truancy, lying, stealing, learning problems
  • Fear: burglars, obsessions
• Adolescence
  
  • Stress: identity crisis, sexual acting out, substance abuse, delinquency
  • Fear: war, death

Question 11

What are some Factors in Non-compliance of children/adolescents?

Answer 11

• Denial or lack of acceptance of the disorder
• Frustration w/ 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 w/ health care time
• Psychotherapy
  
  • Depression
  • Suicidal intent
  • Attention deficit hyperactivity disorder
  • Anorexia nervosa or bulimia

Question 12

What are some Family Factors in child/adolescent behavior?

Answer 12

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

Question 13

What are some Treatment-Related Factors in child/adolescent behavior?

Answer 13

• Interference w/ usual activities
• Side effects of drugs (pain, nausea, weight gain, hair loss)
• Clarity of connection btwn non-compliance & sequelae
• Disinterested, inconsistent medical personnel

Question 14

**Emotional & Behavioral Actions Should Be Anticipated **

Minimize separations from parents, especially for children under ______.

Understand that the child/adolescent needs to _____ something in the environment & arrange the milieu so that this will not interfere w/ treatment

Do not ______ or ______ the child or parents for regressive behavior

Answer 14

8 years old

control

criticize, blame

Question 15

What are some indications for consultation with a child/adolescent psychiatrist after the initial screening assessment?

Answer 15

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

Question 16

What is the difference in symptoms of medical illness?

• Infancy (0-2)
• Early childhood (2-6)
• School age (6-12)
• Adolescence
• Parents

Answer 16

• Infancy (0-2)
  
  • change in routine, separation from parents, stranger anxiety, encourage parents to “live in” hospital
• Early childhood (2-6)
  
  • separation, aggressive to physicians, regressed bowel/bladder control, fear of minor procedures, fear of bodily harm
• School age (6-12)
  
  • behavioral regression, oppositional, irrational explanation of illness
• Adolescence
  
  • loss of privacy & autonomy are painful
• Parents
  
  • mourning, anger, resentment, guilt, denial